Digestion & Metabolism 2: Diabetic Ketoacidosis Flashcards
DIABETIC KETOACIDOSIS (DKA)….
is a ____ form of diabetes mellitus
causes EXCESS ___-___ that result in ____ and SEVERE ____ ___ that can even be ____-___
COMPLICATED form
causes EXCESS KETO-ACIDS that result in ACIDOSIS and SEVERE ELECTROLYTE ABNORMALITIES that can even be LIFE-THREATENING
DKA tends to develop in ____ animals that are VERY ___
why? (give 5 steps)
DIABETIC, SICK
why?
1. CONCURRENT ILLNESS to DIABETES
- causes STRESS
- release of GCC (counter-regulatory hormone)
- causes INSULIN RESISTANCE (persistent hyperglycemia)
- without INSULIN, causes KETO-ACID PRODUCTION (no glucose in cells)
5 common CONCURRENT diseases that can cause DKA?
- HEPATIC LIPIDOSIS
- CHRONIC RENAL FAILURE
- ACUTE PANCREATITIS
- BACTERIAL or VIRAL infections
- NEOPLASIA
treatment with ___ may help INCREASE/DECREASE risk of DKA
INSULIN, DECREASE risk of DKA
what ketone is detected on URINE DIPSTICK?
what ketone is detected on KETONE METER?
URINE DIPSTICK = ACETOACETONE
KETONE METER = D-BETA-HYDROXYBUTYRATE
KETONE BODY SYNTHESIS starts from WHAT molecule?
how is this molecule initially made?
what hormones should be HIGH vs. LOW in regards to BLOOD GLUCOSE?
KETONE BODY SYNTHESIS starts from ACETYL-CoA
initially made from FAT BREAKDOWN because NOT ENOUGH GLUCOSE
hormones..
INSULIN = LOW
COUNTER-REGULATORY HORMONES = HIGH
in DIABETES MELLITUS, there is ____ SYNTHESIS of ____-____ due to DECREASED ____ and INCREASED ____ resulting in EXCESS ____ ____ ____
EXCESS, ACETYL-CoA, INSULIN GLUCOAGON, FATTY ACID OXIDATION
4 CONTRIBUTING FACTORS to METABOLIC ACIDOSIS?
- formation of KETO-ACIDS
- VOMITING
- DEHYDRATION
- RENAL HYPOPERFUSION
DKA can include clinical signs that include CHRONIC ____ ___, such as (2)…
DKA predisposed in WHAT cat breed?
DIABETES MELLITUS…
1. PU/PD
2. POLYPHAGIA
DKA predisposed in SIAMESE
if we see DKA and ABDOMINAL PAIN, can indicate WHAT SECONDARY CAUSE?
PANCREATITIS
TRUE/FALSE
we can see NEUROLOGIC ABNORMALITIES with DKA, such as DULL MENTATION, RECUMBENT & PLANTIGRADE STANCE
TRUE
what 3 CBC ABNORMALITIES can we find in DKA?
what is NORMAL in A CERTAIN SPECIES?
CBC ABNORMALITIES…
1. ANEMIA –> 50% of dos
2. LEFT SHIFT NEUTROPHILIA
3. THROMBOCYTOSIS in DOGS
CATS can have NORMAL PLATELETS
on CHEMISTRY, DOGS tend to have HIGH ____ IN DKA, while in CATS…
what 2 other values are usually also elevated in DOGS?
what 1 other value is usually elevated in CATS?
DOGS TEND TO HAVE HIGH ALP IN DKA, but cats have NORMAL ALP because NO STRESS-INDUCED ALP ISOENZYME
can also have HIGH ALT/AST
cats = AST
3 UA findings in DKA?
- GLUCOSURIA
- KETONURIA –> EMERGENCY
- PROTEINURIA possible
4 changes in ELECTROLYTES in DKA?
- LOW K
- LOW Mg
- LOW P
- LOW Na
why does HYPOKALEMIA occur in DKA?
4 common clinical signs?
what MEDICAL INTERVENTION can WORSEN HYPOKALEMIA?
because if ACIDOTIC, can EXCHANGE CELLS TAKING IN H+ for EXCRETING K+ IN URINE
4 common clinical signs?
1. MUSCLE WEAKNESS
2. PARALYSIS
3. RESPIRATORY DEPRESSION
4. CARDIAC ELECTRIC CONDUCTION ABNORMALITIES
can make hypokalemia worse by GIVING FLUIDS
3 CAUSES for HYPONATREMIA?
- activation of Na/H EXCHANGER to CORRECT ACIDIC pH (H+ in, Na excreted out)
- OSMOTIC DIURESIS
- HYPERLIPIDEMIA
2 SIGNIFICANT CLINICAL SIGNS from HYPONATREMIA…
- CEREBRAL SWELLING
- ALTERED MENTAL STATUS
2 CAUSES for HYPOMAGNESEMIA? (low Mg)
- INSUFFICIENT DIETARY INTAKE of Mg
- INCREASED RENAL EXCRETION of Mg
TREATMENT of DKA…
what is MOST IMPORTANT treatment we can do?
SECOND MOST important treatment?
THIRD MOST important? how must this be done? (2)
MOST IMPORTANT = DO IV FLUIDS!
SECOND-MOST important = CORRECT ELECTROLYTE ABNORMALITIES
THIRD MOST important = CORRECTION OF HYPERGLYCEMIA
1. must be done SLOWLY to AVOID EXTREME OSMOTIC SHIFTS
2. give GLUCOSE every 4-6 HOURS
ELECTROLYTE ABNORMALITIES in DKA tend to develop WHEN?
within FIRST 48 HOURS of TREATMENT
once we start administering IV FLUIDS to DKA patient, how will GLUCOSE levels change?
will start to LOWER BLOOD GLUCOSE CONCENTRATIONS
