Diabetic Emergencies: Diabetic ketoacidosis (DKA)
Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes mellitus. The previously undiagnosed diabetic is most at risk, although the poorly regulated diabetic may also develop DKA. That condition can be considered as the end of a continuous spectrum of decompensated diabetes in cats or dogs. The critical nature of the disease requires aggressive treatment and, almost invariably, long-term hospitalization with 24 hours monitoring by a trained veterinary nurse.
Learn more about Diabetes Mellitus in Dogs and Cats
Key to the cause of DKA is a relative deficiency of insulin. Insulin is produced and secreted by a specific part of the pancreas in response to a rise in blood glucose concentrations. Insulin stimulates cellular uptake of glucose to provide energy for most cells of the body, particularly muscle, adipose tissue, and hepatic cells. When glucose is unavailable as a substrate, most cells are able to use free fatty acids (FFAs) instead as an energy source. Certain cells and organs have absolute requirements for glucose; these include the brain, retina, reproductive system. Brain cells are unique in that they do not require insulin for glucose uptake, but unlike most tissues, the brain cannot use fatty acids for energy. Instead, ketone bodies can provide the brain with two-thirds of its energy needs in periods of fasting or starvation. These strong acids (ketones), namely β-hydroxybutyric acid and acetoacetic acid, are strong acids and dissociate at physiological pH which results in the metabolic acidosis of DKA that leads to weakness, dehydration, loss of appetite, vomiting, and more severe symptoms that can lead to death.
Successful treatment of DKA is complex and involves the correction of many derangements. The goals of treatment encompass correcting dehydration with its electrolyte disturbances, correcting the acid-base imbalance, decreasing blood glucose concentrations, ridding the body of detectable ketones, and treating any underlying or coexisting disease that in some cases could involve pancreatitis, infections, and/or liver diseases.
The complicated pathogenesis of DKA creates a considerable medical challenge for veterinary practitioners. For that reason, we strongly recommend that diabetic patients should be closely monitored during the initial period of treatment, and have regular follow-ups planned by your veterinarian in advance to prevent further complications like DKA.
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Written by: Dr. David Perez, ABVC Veterinarian
