DKA Flashcards
Bicarbonate therapy
70% of tx dogs and cats are discharged from hospital
degree of base deficit is associated with outcome
dogs with HAC
usually is not needed, and its use is controversial.
5 to 6 days of hospitalization.
prognostic
less likely to be discharged from the hospital
ketone are
product of mitochondrial β-oxidation of fatty acids
synthesized from acetyl-coenzyme A (acetyl-CoA)
glucagon
catabolic effects of glucagon include
facilitates synthesis of acetyl-CoA
glycogenolysis, proteolysis, and lipolysis
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
ATP
pyruvate by glycolysis is decreased
acetyl-CoA
ketone body synthesis
three ketones:
2 final ketones:
acetoacetate, β-hydroxybutyrate, acetone
acetoacetate - metab. β-hydroxybutyrate or acetone
which ketones are strong acids:
Acetoacetate and β-hydroxybutyrate
is it true that DKA patients have zero or undetectable endogenous insulin?
explan the importance of counterreg. hormones even in dogs:
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
List counter reg. hormones:
explain why CKs are important:
in this study were CK or counterreg hormone changes more pronounced?
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
% concurrent dxz dog vs cat
most common dog:
most common in cat:
T/F most dogs/cats w DKA are newly dx diabetics
70% 90%
pancreatitis, UTI, HAC
hepatic lipidosis, CKD, pancreatitis, infections, neoplasia
True
Approximately 50% of dogs with DKA have what CBC changes:
nonregenerative anemia
neutrophilia with a left shift
or thrombocytosis
Cats significantly more ____ body formation and degree is correlated with plasma
Heinz body
β-hydroxybutyrate concentration
extracellular K initially high why?:
dehydration
solute drag
acidemia
Hypokalemia:
may be exacerbated by binding of potassium to
fluids osmotic diuresis
insulin
ketoacids
total body phosphorous depletion MoA
Hypophosphatemia CS:
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)
Low sodium concentration may develop secondary to hyperglycemia as intracellular fluid shifts to the extracellular compartment because of hyperglycemia a.k.a
pseudohyponatremia
decrease of 1.6 mEq/L in sodium
100 mg/dl increase in glucose
urine ketones detects:
not sensitive b/c dominant ketoacid is:
acetoacetate
β-hydroxybutyrate
mechanism by which fluid therapy alone decreases blood glucose concentration is incompletely understood, hypoth. MoA:
improving renal perfusion decreases glucagon
K < 0.2 =
0.5mEq/kg/hr Kmax
potassium phosphate contains
rate of
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/
hypoMg CRI tox. CS
vomiting, weakness, generalized flaccid m, mental dullness, bradycardia, respiratory depression, and hypotension
insulin therapy after an average of ___ with no insulin
why is it harmful to start insulin too soon:
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
IM protocol and monitoring
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
American Diabetes Association recommends bicarbonate supplementation only if:
risks:
arterial pH remains < 7.0 after 1 hour of fluid therapy
cerebral edema, exacerbation of hypokalemia, increased hepatic production of ketones, paradoxical CNS acidosis
retrospective study of 127 dogs w DKA reported that the degree of acidosis was associated with poor outcome
HCO3?
IV HCO3 was also associated with poor outcome
fasted for more than 3 days and cats with any duration of anorexia must be treated with
enteral or parenteral nutrition
recurrence
7% of dogs and up to 40% of cats
tx summary
fluids 6 hours (osmotic shifts)
K and Phos suppliment (KPhos 4.4/3)
insulin R
NG tube
