Changes

There is '''whole body loss of electrolytes''' including sodium, potassium, magnesium and phosphate and there is also intracellular redistribution of electrolytes following insulin therapy which may compound plasma deficiencies.

There is '''whole body loss of electrolytes''' including sodium, potassium, magnesium and phosphate and there is also intracellular redistribution of electrolytes following insulin therapy which may compound plasma deficiencies.

Complications of the disease include: '''hyperviscosity, thromboembolism, severe metabolic acidosis, renal failure and death'''.

Complications of the disease include: '''hyperviscosity, [[thromboembolism]], severe metabolic acidosis, [[:Category:Renal Failure|renal failure]] and death'''.

==Differential Diagnoses==

==Differential Diagnoses==

These fall in '''three categories''':

These fall in '''three categories''':

#'''Diabetic cats with another condition'''. Cats with DKA which do not respond to therapy within 1-2 days should be suspected of having an underlying condition such as acute necrotising pancreatitis or sepsis.

#'''Diabetic cats with another condition'''. Cats with DKA which do not respond to therapy within 1-2 days should be suspected of having an underlying condition such as acute necrotising [[pancreatitis]] or sepsis.

#'''Nonketotic hyperosmolar diabetes'''. There is extreme hyperglycaemia, hyperosmolarity, depression and dehydration but no ketosis or acidosis.

#'''Nonketotic hyperosmolar diabetes'''. There is extreme hyperglycaemia, hyperosmolarity, depression and dehydration but no ketosis or acidosis.

#'''Severe illness resulting in depression and dehydration''' preceded by polyuria and polydipsia. This may occur when acute renal failure occurs on top of chronic renal failure. There will be no ketonuria or glucosuria and no marked hyperglycaemia.

#'''Severe illness resulting in depression and dehydration''' preceded by polyuria and polydipsia. This may occur when [[Acute Renal Failure|acute renal failure]] occurs on top of [[Chronic Renal Failure|chronic renal failure]]. There will be no ketonuria or glucosuria and no marked hyperglycaemia.

==Clinical Signs==

==Clinical Signs==

<u>Biochemistry findings</u>:

<u>Biochemistry findings</u>:

 

:Marked '''hyperglycaemia''', usually over 30mmol/L

Marked '''hyperglycaemia''', usually over 30mmol/L

:Plasma '''pH < 7.3'''

 

:'''Ketonaemia'''

Plasma '''pH < 7.3'''

:Increased liver enzymes (ALP, AST)

 

:'''Electrolyte changes''': levels will guide treatment and should be monitored 2-3 times a day. Potassium and phosphate may be normal or elevated on admission, but drop rapidly once therapy is initiated.

'''Ketonaemia'''

 

Increased liver enzymes (ALP, AST)

 

'''Electrolyte changes''': levels will guide treatment and should be monitored 2-3 times a day. Potassium and phosphate may be normal or elevated on admission, but drop rapidly once therapy is initiated.

<u>Urinalysis findings</u>:

<u>Urinalysis findings</u>:

 

:'''Glucosuria'''

'''Glucosuria'''

:'''Ketonuria''': usually there is a positive dipstick reaction. Beta-hydroxybutyrate is the predominant ketone in cats, but it is metabolised to acetoacetate and acetone after several days, and these are the ketones detected by dipsticks.

 

:Signs of a '''urinary tract infection''' may be present: pyuria and bacturia

'''Ketonuria''': usually there is a positive dipstick reaction. Beta-hydroxybutyrate is the predominant ketone in cats, but it is metabolised to acetoacetate and acetone after several days, and these are the ketones detected by dipsticks.

 

Signs of a '''urinary tract infection''' may be present: pyuria and bacturia

<u>Haematology findings</u>:

<u>Haematology findings</u>:

 

:[[Stress Leucogram|'''Stress leukogram''']] or an inflammatory leukogram if an inflammatory focus is present.

'''Stress leukogram''' or an inflammatory leukogram if an inflammatory focus is present.

<u>Radiography and ultrasonography</u>: may be indicated to assist in identifying intercurrent conditions such as pancreatitis.

<u>Radiography and ultrasonography</u>: may be indicated to assist in identifying intercurrent conditions such as pancreatitis.

#'''<u>Insulin</u>''': this is needed to stop ketone formation and provide glucose to insulin sensitive tissues. '''Insulin therapy can worsen hypokalaemia and hypophosphataemia''', and fluid and electrolyte correction should be started before insulin is administered. Insulin therapy should be commenced '''1-2 hours after fluids are started''', but no more than 4 hours after fluid therapy is started, ideally when potassium levels are normal. The goal of therapy is to '''decrease serum glucose by 4mmol/L/hour until 12-14mmol/L'''. '''Continuous intravenous protocols and intramuscular protocols''' are available, depending on the clinical setting. Once serum glucose is maintained at 10-14mmol/L, insulin can be given '''subcutaneously every 6-8 hours'''.

#'''<u>Insulin</u>''': this is needed to stop ketone formation and provide glucose to insulin sensitive tissues. '''Insulin therapy can worsen hypokalaemia and hypophosphataemia''', and fluid and electrolyte correction should be started before insulin is administered. Insulin therapy should be commenced '''1-2 hours after fluids are started''', but no more than 4 hours after fluid therapy is started, ideally when potassium levels are normal. The goal of therapy is to '''decrease serum glucose by 4mmol/L/hour until 12-14mmol/L'''. '''Continuous intravenous protocols and intramuscular protocols''' are available, depending on the clinical setting. Once serum glucose is maintained at 10-14mmol/L, insulin can be given '''subcutaneously every 6-8 hours'''.

#'''<u>Food</u>''': cats should be '''encouraged to eat''' using palatable food, preferable low carbohydrate. However any food is better than no food.

#'''<u>Food</u>''': cats should be '''encouraged to eat''' using palatable food, preferable low carbohydrate. However any food is better than no food.

#'''<u>Intercurrent disease</u>''': this needs an appropriate management plan, such as antibiotics if bacterial infection is present, or treatment for pancreatitis, congestive heart failure, renal failure, dioestrus.

#'''<u>Intercurrent disease</u>''': this needs an appropriate management plan, such as antibiotics if bacterial infection is present, or treatment for pancreatitis, congestive [[:Category:Heart Failure|heart failure]], renal failure, dioestrus.

==Prognosis==

==Prognosis==

The prognosis is usually '''guarded to poor''', depending on the stage of disease at presentation, and the presence of any intercurrent diseases. Delay in seeking treatment and inability to provide intensive care may affect survival.

The prognosis is usually '''guarded to poor''', depending on the stage of disease at presentation, and the presence of any concurrent diseases. Delay in seeking treatment and inability to provide intensive care may affect survival.

{{Learning

{{Learning

 

[[Category:To Do - Helen]]

[[Category:Endocrine Diseases - Cat]][[Category:Endocrine Diseases - Dog]]

[[Category:To Do - Review]]

[[Category:Expert Review - Small Animal]]