DKA

Question 1

Bicarbonate therapy

70% of tx dogs and cats are discharged from hospital

degree of base deficit is associated with outcome

dogs with HAC

Answer 1

usually is not needed, and its use is controversial.

5 to 6 days of hospitalization.

prognostic

less likely to be discharged from the hospital

Question 2

ketone are

Answer 2

product of mitochondrial β-oxidation of fatty acids

synthesized from acetyl-coenzyme A (acetyl-CoA)

Question 3

glucagon

catabolic effects of glucagon include

Answer 3

facilitates synthesis of acetyl-CoA

glycogenolysis, proteolysis, and lipolysis

Question 4

describe how ketones form in DKA:

nondiabetics, acetyl-CoA and pyruvate enter the citric acid cycle to form

diabetic patients, glucose does not enter cells .:. production of ____ by ____ is decreased

activity of the citric acid cycle is .:. diminished, resulting in decreased utilization of _____

The net effect of increased production and decreased utilization = > acetyl-CoA precursor ketones

Answer 4

ATP

pyruvate by glycolysis is decreased

acetyl-CoA

ketone body synthesis

Question 5

three ketones:

2 final ketones:

Answer 5

acetoacetate, β-hydroxybutyrate, acetone

acetoacetate - metab. β-hydroxybutyrate or acetone

Question 6

which ketones are strong acids:

Answer 6

Acetoacetate and β-hydroxybutyrate

Question 7

is it true that DKA patients have zero or undetectable endogenous insulin?

explan the importance of counterreg. hormones even in dogs:

Answer 7

previously believed DKA patients have zero or undetectable endogenous insulin.

study that included 7 dogs with DKA, 5 had detectable endogenous serum insulin concentrations, and 2 WRI

Question 8

List counter reg. hormones:

explain why CKs are important:

in this study were CK or counterreg hormone changes more pronounced?

Answer 8

glucagon, cortisol, or catecholamine

recent study in dogs found IL-18, resistin, granulocyte-monocyte colony-stimulating factor concentrations were significantly higher in dogs with DKA

Additionally, IL-8 and monocyte chemoattractant protein 1 were significantly higher in dogs with uncomplicated diabetes compared with healthy controls

unknown whether cytokine dysregulation observed in patients with DKA is due to presence of concurrent disorders or other reasons.

cytokine concentrations were more pronounced than the changes noted in glucagon concentration

Question 9

% concurrent dxz dog vs cat
most common dog:
most common in cat:

T/F most dogs/cats w DKA are newly dx diabetics

Answer 9

70% 90%
pancreatitis, UTI, HAC
hepatic lipidosis, CKD, pancreatitis, infections, neoplasia

True

Question 10

Approximately 50% of dogs with DKA have what CBC changes:

Answer 10

nonregenerative anemia
neutrophilia with a left shift
or thrombocytosis

Question 11

Cats significantly more ____ body formation and degree is correlated with plasma

Answer 11

Heinz body

β-hydroxybutyrate concentration

Question 12

extracellular K initially high why?:

Answer 12

dehydration
solute drag
acidemia

Question 13

Hypokalemia:

may be exacerbated by binding of potassium to

Answer 13

fluids osmotic diuresis
insulin
ketoacids

Question 14

total body phosphorous depletion MoA

Hypophosphatemia CS:

Answer 14

phosphate shifts from ICS to ECS sendondary to hyperglycemia, acidosis, and hypoinsulinemia

excreted as osmotic diuresis

with hemolysis (in a cat) and seizures (in a dog)

Question 15

Low sodium concentration may develop secondary to hyperglycemia as intra­cellular fluid shifts to the extracellular compartment because of hyperglycemia a.k.a

Answer 15

pseudohyponatremia

Question 16

decrease of 1.6 mEq/L in sodium

Answer 16

100 mg/dl increase in glucose

Question 17

urine ketones detects:

not sensitive b/c dominant ketoacid is:

Answer 17

acetoacetate

β-hydroxybutyrate

Question 18

mechanism by which fluid therapy alone decreases blood glucose concentration is incompletely understood, hypoth. MoA:

Answer 18

improving renal perfusion decreases glucagon

Question 19

K < 0.2 =

Answer 19

0.5mEq/kg/hr Kmax

Question 20

potassium phosphate contains

rate of

Answer 20

potassium phosphate (solution contains 4.4 mEq/ml of potassium and 3 mM/ml of phosphate) at a rate of 0.03 to 0.12 mM/kg/

Question 21

hypoMg CRI tox. CS

Answer 21

vomiting, weakness, generalized flaccid m, mental dullness, bradycardia, respiratory depression, and hypotension

Question 22

insulin therapy after an average of ___ with no insulin

why is it harmful to start insulin too soon:

Answer 22

6 hours

fluid therapy alone decreases blood glucose concentration significantly during the first few hours

• insulin is an effective osmole
• fluid therapy might decrease the blood glucose (and electrolyte) concentrations too rapidly, resulting in potentially harmful osmotic shifts

Question 23

IM protocol and monitoring

Answer 23

q1 admin, q1 measured
initial dose 0.2 U/kg regular insulin, 0.1 U/kgq1, 0.05 U/kg/hr, 0.1 U/kg/hr, or 0.2 U/kg/hr if blood glucose concentration drops by more than 75 mg/dl/hr, by 50 to 75 mg/dl/hr, or by less than 50 mg/dl/hr, respectly

Question 24

American Diabetes Association recommends bicarbonate supplementation only if:

risks:

Answer 24

arterial pH remains < 7.0 after 1 hour of fluid therapy

cerebral edema, exacerbation of hypokalemia, increased hepatic production of ketones, paradoxical CNS acidosis

Question 25

retrospective study of 127 dogs w DKA reported that the degree of acidosis was associated with poor outcome

HCO3?

Answer 25

IV HCO3 was also associated with poor outcome

Question 26

fasted for more than 3 days and cats with any duration of anorexia must be treated with

Answer 26

enteral or parenteral nutrition

Question 27

recurrence

Answer 27

7% of dogs and up to 40% of cats

Question 28

tx summary

Answer 28

fluids 6 hours (osmotic shifts)
K and Phos suppliment (KPhos 4.4/3)
insulin R
NG tube