Diabetic Ketoacidosis, Canine - contd.
Diabetic ketoacidosis is probably the most serious complication that can develop in association with diabetes mellitus. Used for energy production in most body tissues, ketones, also called ketone bodies, normally form when fatty acids are released from fatty tissue and are transported to the liver. The liver then makes ketones from the fatty acids. Excessive production of ketones can occur in uncontrolled diabetes mellitus, and as they accumulate, ketosis, and eventually acidosis, develop. The four major factors that contribute to ketone formation in DKA are insulin deficiency, fasting, dehydration, and increased levels of "stress" hormones such as epinephrine, cortisol, glucagon, and growth hormone.
DKA occurs more commonly in animals with previously undiagnosed diabetes mellitus, but it can also be seen in dogs with established diabetes that are not receiving enough insulin. In these dogs, there may be an associated inflammatory or infectious disease. Other canines may develop conditions associated with insulin resistance such as hypothyroidism or Cushing's disease. Dogs may be only mildly affected by DKA, or they may be close to death at the time of diagnosis. DKA develops at an unpredictable rate, and some diabetic dogs may be able to live fairly normal lives for several months with no treatment at all. However, once DKA develops, most dogs become seriously ill within one week.
The aggressiveness of treatment depends on how sick the dog is. While dogs with mild DKA may be successfully treated with intravenous fluids and insulin, dogs with severe manifestations of disease will need more significant intervention. Fluid therapy, potassium, bicarbonate, and phosphorus supplementation can be vitally important. Any accompanying disorders must be identified and treated specifically where possible to enhance resolution of DKA.
Complications during DKA treatment are common, and can include the development of hypoglycemia, neurological signs due to brain cell swelling, and severe electrolyte abnormalities. Anemia due to red blood cell breakdown can occur if the serum phosphorus concentration drops too low. Acute kidney failure also is possible.
DKA is one of the most serious metabolic disorders seen in both human and veterinary medicine. Many patients will die from it. However, the majority of patients can pull through a crisis successfully with aggressive diagnostics and treatment.
