Canine Diabetic Ketosis-Ketoacidosis: A Retrospective Study of 23 Cases (1997-2013)

Abstract

ABSTRACT. The purpose of this retrospective study was to describe the historical and clinical findings, the clinicopathological abnormalities, the occurrence and nature of concurrent diseases, the treatment and outcome of 23 dogs with diabetic ketosisketoacidosis (DK-DKA). Inclusion criteria consisted of the presence of clinical signs suggestive of diabetes mellitus (DM) along with persistent hyperglycemia, glycosuria and ketonuria during the first 24 hours of hospitalization. In nineteen dogs (83%) DM had not been previously diagnosed. Common presenting complaints were polyuria/polydipsia (100%), partial or complete loss of appetite (87%), depression (87%), vomiting (65 %) and weight loss (30 %). The most frequent physical examination findings included dehydration (61%), depression (61%), hypotrichosis-alopecia (39%), palpable cranial abdominal organomegaly (26%), pendulous abdomen (26%), lesions compatible with superficial pyoderma (17%), thin and hypotonic abdominal skin (17%), and hypothermia (17%). The most important clinicopathological abnormalities, apart from hyperglycemia, glucosuria, and ketonuria, included anemia (48%), leukocytosis (39%), increased activities of alkaline phosphatase (100%), lipase (56%) and alanine aminotransferase (52%), hypertriglyceridemia (90%) and hypercholesterolemia (84%). Also, 12 dogs demonstrated hypokalemia on admission or during hospitalization. A concurrent disease was identified in 74% of the cases while 26% had two or more comorbidities. The latter included pancreatitis (30%), urinary tract infections (17%), superficial pyoderma (17%), urolithiasis (13%) and hyperadrenocorticism (13%). Twenty two dogs were treated with short-acting insulin (regular or lispro) and one with intermediate-acting (lente) insulin, whereas intravenous fluid therapy was instituted in 78% of them with potassium and phosphorus supplementation in 65% and 9%, respectively. Seventeen (81%) dogs survived to be discharged, three (13%) died during hospitalization, one (4%) was euthanized and on two (9%) occasions owners declined hospitalization after the first 24 hours due to financial constrains or a poor prognosis. Mean duration of hospitalization for the survivors was 5.7 ± 2.4 days, mean time to resolution of ketonuria was 4.2 ± 1.9 days and median time of rapid-acting insulin administration was 4 days (range 2-8 days).

The sodium correction factor for dogs undergoing treatment for a hyperglycemic crisis is a 1.6-mEq/L decrease in sodium per 100-mg/dL increase in glucose

“…Previous studies have reported pancreatitis, urinary tract infections, and hyperadrenocorticism as the most common concurrent diseases in canine patients with DKA. [23][24][25] These comorbidities were also common in the present study. It is also notable that renal (21% [16/76]) and cardiac (30% [23/76]) disease were common in the present study's patient population, as these disease processes have many mechanisms through which they can affect sodium concentration, glucose concentration, and total body water content.…”

“…The percentage of patients with concurrent diseases (93% [71/76]) was higher than previously reported (up to 74%). 23,24 However, prior studies defined concurrent diseases as only those for which confirmatory testing had been performed, while the present study recorded all identified or clinically suspected problems regardless of confirmatory testing. 23,24 The broader definition in this study and the patient population presenting to our referral institution likely accounted for the increased percentage of concurrent diseases.…”

“…23,24 However, prior studies defined concurrent diseases as only those for which confirmatory testing had been performed, while the present study recorded all identified or clinically suspected problems regardless of confirmatory testing. 23,24 The broader definition in this study and the patient population presenting to our referral institution likely accounted for the increased percentage of concurrent diseases. Previous studies have reported pancreatitis, urinary tract infections, and hyperadrenocorticism as the most common concurrent diseases in canine patients with DKA.…”