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Diabetic patients that are not well regulated are at risk for entering a ketoacidotic state. The DKA state occurs when the body metabolizes alternate energy sources (i.e. fats instead of carbohydrates). The breakdown of alternate energy sources results in the accumulation of ketone bodies in the blood. These ketone bodies are acidic and lower the normally neutral pH of the blood. Multiple organ systems are adversely affected by a low blood pH, especially the nervous, cardiovascular and renal (kidney) systems. The severity of organ system damage is directly related to how acidotic the patient becomes. Thus, early identification and early, aggressive treatment is necessary for a good outcome.

Both dogs and cats can be affected. Diabetic ketoacidosis can occur when a diabetic patient goes undiagnosed; however, previously diagnosed diabetics that develop concurrent disease are at risk. We generally think of diabetics as being in a relatively fragile state of balance/compensation. If another disease/problem develops, this balance can be thrown off, leading to decompensation that is often severe. The most common concurrent diseases resulting in DKA are pancreatitis, skin or urinary tract infections, Cushing’s disease and gastroenteritis.

DKA animals usually display lethargy and weakness that can be extreme; mental dullness to a moribund state; anorexia; vomiting; rapid breathing. Upon presentation to a veterinary hospital, the diagnosis is made by documentation of a low blood pH and ketones in the urine or blood. Initiation of aggressive treatment after diagnosis is often necessary. The mainstay of therapy is typically supportive and symptomatic: intravenous fluid therapy; electrolyte and dextrose supplementation; frequent administration or a continuous infusion of a short-acting insulin; and medications for nausea and vomiting. Often antibiotics are used if a concurrent infection is suspected. The blood glucose must be closely monitored every 2-4 hours and the insulin dose is typically adjusted frequently, as these patients’ needs can vary hour by hour. Until the underlying/concurrent disease is diagnosed and treated, tight control in unlikely.

The typical hospital stay for a DKA patient is several days to a week or more. If an underlying disease can be identified with specific treatment initiated and the patient eats and drinks well, they are slowly weaned off of their in-hospital therapy and started back on a long acting insulin plan. The dose of insulin is usually not what it was before the DKA event. Essentially, we have to start again with insulin dosing, using conservative doses at first and then gradually making increases, in small increments, as needed. After the patient is sent home, relatively frequent visits to the hospital will be necessary for the first two to three months.

If an underlying disease cannot be identified, the prognosis becomes poorer. We continue to control the patient the best we can, but recurrence of a DKA event is possible. Owners must carefully monitor their pet.

It is important for owners to realize that a DKA patient can be very frustrating to manage for the owner and the veterinarian alike. A strong dedication is imperative. Long-term presumptions can usually not be made, as these patients are very dynamic, and we just deal with changes as they come up.