Feline acute patient physiologic and laboratory evaluation scores and other prognostic factors in cats with first-time diabetic ketoacidosis.

BACKGROUND: Acute Patient Physiologic and Laboratory Evaluation (APPLE) scores have not been reported in cats with diabetic ketoacidosis (DKA). HYPOTHESIS: In cats with DKA, APPLE scores will be significantly higher in non-survivors compared with survivors and these scores will predict mortality. ANIMALS: Sixty-eight cats with DKA. METHODS: Retrospective study. The APPLE scores, blood glucose concentration (BG), venous pH, and ketone concentrations were compared between survivors and non-survivors. Simple logistic regression was used to determine if these variables predict the binary variable of survival or non-survival, and if they did, an empirical optimal cut point for mortality prediction was calculated. RESULTS: The APPLEfast and APPLEfull scores were significantly higher in non-survivors (30 cats; 24.6 ± 7.4 and 45.2 ± 7.3 , respectively) compared with survivors (38 cats; 20.9 ± 6.2 and 41.7 ± 6.5 ; P = .01 and P = .02, respectively). The APPLEfast (P = .03) but not the APPLEfull scores (P = .06) predicted mortality. For every 1 unit increase in the APPLEfast score, the odds of death increased by 1.08 (95% confidence interval [CI], 1.006-1.17; P = .03). Median BG was significantly higher in non-survivors (431 mg/dL; range, 260-832 mg/dL) compared with survivors (343 mg/dL; range, 256-738 mg/dL; P = .01) and BG predicted mortality (P = .02). For every 1 mg/dL increase in BG, the odds of death increased by 1.004 (95% CI, 1.0006-1.008). Empirical optimal cut points for APPLEfast and BG mortality prediction were 24.5 and 358 mg/dL, respectively. CONCLUSIONS AND CLINICAL IMPORTANCE: The APPLEfast score and BG predict mortality in cats with DKA and can be used to stratify populations by risk of mortality in clinical trials of DKA in cats.

Comparison of insulin infusion protocols for management of canine and feline diabetic ketoacidosis.

OBJECTIVE: Describe the use of fixed-rate intravenous insulin infusions (FRIs) in cats and dogs with diabetic ketoacidosis (DKA) and determine if this is associated with faster resolution of ketosis compared to variable-rate intravenous insulin infusions (VRIs). Secondary objectives were to evaluate complication rates, length of hospitalization (LOH), and survival to discharge (STD). DESIGN: Randomized clinical trial (January 2019 to July 2020). SETTING: University veterinary teaching hospital and private referral hospital. ANIMALS: Dogs and cats with DKA and venous pH <7.3, blood glucose concentration >11 mmol/L (198 mg/dL), and ß-hydroxybutyrate (BHB) concentration >3 mmol/L were eligible for inclusion. Patients were randomly assigned to receive either FRI or VRI. INTERVENTIONS: Neutral (regular) insulin was administered IV as an FRI or VRI. For FRI, the rate was maintained at 0.01 IU/kg/h. For VRI, the dose was adjusted according to blood glucose concentration. MEASUREMENTS AND RESULTS: Sixteen cats and 20 dogs were enrolled. Population characteristics, mean insulin infusion rate, time to resolution of ketosis (BHB <0.6 mmol/L), complications, LOH, and STD were evaluated. In cats, overall resolution of ketosis was low (9/16 [56.3%]), limiting comparison of protocols. In dogs, resolution of ketosis was high (19/20 dogs [95.0%]) but the time to resolution in the FRI group was not different than that in the VRI group (P = 0.89), despite a 25% higher average insulin infusion rate in the FRI group (P = 0.04). The incidence of complications was low and did not differ between protocols. In cats, LOH and STD did not differ between protocols. All cats that died (5/16) did so within 78 hours and none had resolution of ketosis. Dogs receiving FRI had a shorter LOH (P = 0.01) but STD did not differ between protocols. Six dogs (30.0%) did not survive to hospital discharge but all had resolution of ketosis. CONCLUSIONS: FRIs can be used in veterinary species but may not hasten resolution of ketosis.

Safety and effectiveness of the sodium-glucose cotransporter inhibitor bexagliflozin in cats newly diagnosed with diabetes mellitus.

BACKGROUND: Bexagliflozin is a sodium-glucose cotransporter 2 (SGLT2) inhibitor. A pilot study has shown that bexagliflozin can decrease dependence on exogenous insulin in cats with diabetes mellitus (DM). OBJECTIVE: To evaluate the safety and effectiveness of bexagliflozin as a monotherapy for DM in previously untreated cats. ANIMALS: Eighty-four client-owned cats. METHODS: Historically controlled prospective open-label clinical trial. Cats were dosed PO with 15 mg bexagliflozin once daily for 56 days, with a 124-day extension to evaluate safety and treatment effect durability. The primary endpoint was the proportion of cats experiencing a decrease in hyperglycemia and improvement in clinical signs of hyperglycemia from baseline on day 56. RESULTS: Of 84 enrolled cats, 81 were evaluable on day 56, and 68 (84.0%) were treatment successes. Decreases in mean serum glucose, fructosamine, and ß-hydroxybutyrate (ß-OHB) concentrations were observed, and investigator assessments of cat neurological status, musculature, and hair coat quality improved. Owner evaluations of both cat and owner quality of life were favorable. The fructosamine half-life in diabetic cats was found to be 6.8 days. Commonly observed adverse events included emesis, diarrhea, anorexia, lethargy, and dehydration. Eight cats experienced serious adverse events, 3 of which led to death or euthanasia. The most important adverse event was euglycemic diabetic ketoacidosis, diagnosed in 3 cats and presumed present in a fourth. CONCLUSION AND CLINICAL IMPORTANCE: Bexagliflozin decreased hyperglycemia and observed clinical signs in cats newly diagnosed with DM. As a once-daily PO medication, bexagliflozin may simplify management of DM in cats.

Diabetes Ketoacidosis and Hyperosmolar Hyperglycemic Syndrome in Companion Animals.

Diabetes mellitus is a common endocrinopathy in dogs and cats. Diabetes ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) are life-threatening complications of diabetes resulting from an imbalance between insulin and the glucose counter-regulatory hormones. The first part of this review focuses on the pathophysiology of DKA and HHS, and rarer complications such as euglycemic DKA and hyperosmolar DKA. The second part of this review focuses on the diagnosis and treatment of these complications.

Successful multimodal treatment of extreme hypertriglyceridemia in a juvenile diabetic dog.

OBJECTIVE: To describe the therapeutic protocol used to normalize severe hypertriglyceridemia in a dog. CASE SUMMARY: A 7-month-old, 1.2-kg female Pomeranian presented with acute polyuria, polydipsia, and ocular discoloration. Diagnoses included diabetic ketosis, severe hypertriglyceridemia (>225 mmol/L [>20,000 mg/dl]), lipemia retinalis, and bilateral uveitis. The triglyceride concentration was near normal within 2 days of initiating treatment with fenofibrate, regular insulin constant rate infusion (CRI), manual therapeutic plasma exchange (TPE), and a low-fat diet. All clinical signs resolved. The dog has had no relapse of hypertriglyceridemia at the time of writing the manuscript, 6 months later, with continued treatment of diabetes mellitus. NEW OR UNIQUE INFORMATION PROVIDED: This is the first case report documenting the combination of fenofibrate, insulin CRI, and manual TPE for treatment of severe hyperlipidemia in a dog. Detailed protocols for manual TPE and a novel insulin CRI are provided. A discussion of multiple spurious biochemical and hematologic errors associated with the severe hypertriglyceridemia is also provided.

Feline Comorbidities: Clinical perspective on diabetes mellitus and pancreatitis.

PRACTICAL RELEVANCE: Diabetes mellitus (DM) is one of the most common feline endocrine disorders. It has been shown by several studies that DM in cats frequently coexists with pancreatitis. CLINICAL CHALLENGES: It has not been definitively established what the exact pathogenetic association between DM and pancreatitis is in the cat. However, the association between these two conditions is most likely bidirectional, with DM predisposing cats to pancreatitis and vice versa. Diagnosis of pancreatitis in cats with DM is crucial because concurrent pancreatitis commonly leads to difficulties in the management of DM. When pancreatitis is associated with diabetic ketoacidosis (DKA), therapeutic management is even more challenging. AIMS: This review focuses on the concurrent presence of DM or DKA and pancreatitis in cats, mainly focusing on their clinical management. EVIDENCE BASE: Information provided in this review is based on feline-specific clinical research when available. In addition, comparative and human research, as well as clinical experience, has been used to enrich knowledge in areas where feline-specific research is not yet available.

Glargine versus regular insulin protocol in feline diabetic ketoacidosis.

OBJECTIVES: To determine whether basal-bolus administration of glargine insulin is a safe and effective alternative treatment compared to the standard continuous rate infusion (CRI) protocol. DESIGN: Prospective randomized clinical trial. SETTING: University teaching hospital. ANIMALS: Twenty cats diagnosed with diabetic ketoacidosis (DKA). INTERVENTIONS: The cats were block-randomized to either a CRI protocol using regular insulin (CRI-group; n = 10) or a basal-bolus SC and IM glargine protocol (glargine-group, n = 10). Baseline blood gases, electrolytes, glucose, and ß-hydroxybutyrate (ß-OHB) concentrations were measured at the time of admission and later at predefined intervals until reaching the primary endpoint of the study, defined as a ß-hydroxybutyrate concentration < 2.55 mmol/L. MEASUREMENTS AND MAIN RESULTS: The main outcome measure was time (h) to resolution of ketonemia. Secondary outcome measures were time until first improvement of hyperglycemia and ketonemia, decrease of glucose to ≤13.9 mmol/L (250 mg/dL), resolution of acidosis, consumption of first meal, and discharge from hospital. Additionally, occurrence of treatment-associated adverse events and death were compared. Seventeen cats (85%) survived to discharge, with no difference in survival between groups (P = 1.0). Median times to ß-OHB < 2.55 mmol/L were 42 (CRI-group) and 30 (glargine-group) hours, respectively (P = 0.114). Median times to first improvement of hyperglycemia (glargine-group: 2 h; CRI-group: 6 h; P = 0.018) and until discharge from hospital (glargine-group: 140 h; CRI-group: 174 h; P = 0.033) were significantly shorter in the glargine-group. No significant differences were observed in any other parameter under investigation (P > 0.05). CONCLUSIONS: Basal-bolus administration of glargine insulin appears to be an effective and safe alternative to the current standard CRI-protocol for the management of DKA in cats. The positive outcomes and simplicity make it a viable option for the treatment of feline DKA.

Relationship between anti-insulin antibody production and severe insulin resistance in a diabetic cat.

A 5-year-old castrated male domestic shorthair cat was diagnosed with diabetic ketoacidosis and severe insulin resistance. Although the conventional treatment for diabetic ketoacidosis was provided, the cat required frequent hospitalization because of severe dehydration and repeated diabetic ketoacidosis. We detected anti-insulin antibodies for human in this cat. Serum insulin-binding IgG levels were markedly elevated compared with those in healthy cats and other diabetic cats. We initiated prednisolone to suppress the effects of anti-insulin antibodies. After initiation of prednisolone, the cat was gradually recovered with increasing activity and appetite. Furthermore, satisfactory glycemic control was achieved with combined subcutaneous injection of insulin detemir and insulin degludec.

Cutaneous Vasculopathy and Pulmonary Thromboembolism in an Unstable Diabetic Cat.

A 6-year-old, male-neutered, domestic short-haired cat was referred for further management of a 3-month history of uncontrolled diabetes mellitus. The cat visited the hospital on 3 occasions during a 3-week time period. Hyperglycemia was documented at all visits. The cat initially presented with evidence of hypovolemia, cranial abdominal pain, and dehydration. Moderate hyperglycemia, mild ketonemia, and severe hypokalemia were documented. A 3 × 2 cm skin lesion with associated alopecia and erythema was first noticed at a routine follow-up examination (visit 2) 1 week later. A diagnosis of diabetic ketoacidosis was made 6 days later. The previously identified skin lesion now measured 6 × 2.5 cm. Two episodes of respiratory distress were identified at this visit, with no evidence of cardiac or pulmonary pathology. The cat developed a moderate anemia (packed cell volume 16 %, total solids 7.9 g/dL) on the fifth day of hospitalization. Fluid therapy, electrolyte supplementation, regular insulin, anti-emetic, and analgesia medications were administered during visits 1 and 3. Due to development of anemia, suspected pulmonary thromboembolism events and progression of skin lesions, euthanasia was elected. A diagnosis of cutaneous vasculopathy with secondary ischemic necrosis was made postmortem and pulmonary thromboembolism was confirmed. To the authors' knowledge, this is the first report of cutaneous vasculopathy and pulmonary thromboembolism in a cat with confirmed diabetes mellitus, warranting further research to assess if hypercoagulability is common in this patient population, as routine thromboprophylaxis and anticoagulation may be potentially indicated.

Percent recovery of insulin from two different concentrations (3 U/250 mL and 45 U/250 mL) of regular insulin solutions prepared for continuous rate infusion.

OBJECTIVE: To compare the percent recovery of regular insulin prepared for administration as a continuous rate infusion (CRI) using 2 different concentrations, 3 and 45 U in 250 mL 0.9% saline. DESIGN: In vitro experiment SETTING: Privately-owned emergency and referral teaching hospital. ANIMALS: None INTERVENTION: Commercial 250 mL 0.9% sodium chloride IV fluid bags were injected with either 3 U (solution bag A) or 45 U (solution bag B) of regular insulin. The insulin concentration was measured in each bag. A fluid administration and extension set were connected to each bag and 50 mL was drained through the IV tubing. The insulin concentration was then measured from samples post washout. MEASUREMENTS AND MAIN RESULTS: Comparison of the concentration of insulin injected into the bag and concentration of insulin in the bag showed that there was a 29.7 and 37.3% recovery of insulin from solution bag A and solution bag B, respectively. Comparison of the concentration of insulin injected into the bag and concentration of insulin in the post 50-mL washout samples showed that there was an 11.9 and 30.6% recovery of insulin from bags A and B, respectively. CONCLUSIONS: Substantially more insulin was available after a 50-mL washout from solution bag B compared to solution bag A. Insulin binding to the IV bag and fluid administration set is likely the cause of this difference. CLINICAL SIGNIFICANCE: Patients receiving lower concentrations of insulin as a CRI, such as might be prescribed for cats and small dogs may require longer time for resolution of hyperglycemia and ketonemia.

[Beta-hydroxybutyrate measurements with the GlucoMen®LX Plus in the diagnosis of diabetic ketoacidosis in dogs and cats]. / Beta-Hydroxybutyrat-Messung mit dem GlucoMen®LX Plus zur Diagnose der diabetischen Ketoazidose bei Hunden und Katzen.

OBJECTIVE: The measurement of beta-hydroxybutyrate (BOHB) carries high significance for the diagnosis, prognosis as well as treatment decisions in canine and feline diabetic ketoacidosis. The aim of this study was to establish clinically usable cut-off values for BHOB measurements in dogs and cats using the glucometer GlucoMen®LX Plus. MATERIAL AND METHODS: We measured BOHB with the GlucoMen®LX Plus in 4 patient groups (diabetic ketoacidosis, diabetic non-ketoacidic, catabolic non-diabetic status, control). These were classified based upon medical history and laboratory findings (pH, glucose-, HCO3 - concentrations, anion gap). The data was analyzed in a ROC-curve-analysis in order to create cut-off values. RESULTS: A total of 47 dogs and 55 cats were included into the study. In the differentiation between the two diabetic groups, cut-off values for dogs and cats amounted to 2.55 mmol/l and 4.05 mmol/l, respectively. Here, good sensitivity (100 %) and specificity (82 % and 100 %, respectively) were attained. In the comparison of the catabolic non-diabetic status group and the individuals with diabetic ketosis, the analysis resulted in a cut-off value of 0.25 mmol/l in dogs and 0.25 mmol/l in cats, carrying poor sensitivity (58 % and 59 %, respectively) and specificity (90 %). CONCLUSION: Measurements with the GlucoMen®LX Plus are suitable for a reliable differentiation between ketoacidosis and ketosis in dogs and cats. Here, the determined cut-off values carried high sensitivity and specificity. A distinction between non-diabetic catabolic individuals and patients with diabetic catabolic states, however, cannot be achieved with adequate consistency. CLINICAL RELEVANCE: The established cut-off values aid in the treatment decision-making process as well as the assessment of prognosis and treatment success in diabetic ketoacidosis. In representing a point of care technique, the method allows for direct owner communication of the results and immediate adjustment of the treatment regime. Concerning the initial diagnosis or a differentiation between non-diabetic and diabetic catabolic states, however, the presented method alone is not sufficient, therefore additional diagnostic procedures are warranted in order to ascertain a correct diagnosis.

Accuracy of a flash glucose monitoring system in dogs with diabetic ketoacidosis.

BACKGROUND: A factory-calibrated flash glucose monitoring system (FGMS; FreeStyle Libre) recently was evaluated in dogs with uncomplicated diabetes mellitus. It is not known if this system is reliable during diabetic ketoacidosis (DKA). OBJECTIVES: To assess the performance of the FGMS in dogs with DKA and to determine the effect of severity of ketosis and acidosis, lactate concentration, body condition score (BCS), and time wearing the sensor on the accuracy of the device. ANIMALS: Fourteen client-owned dogs with DKA. METHODS: The interstitial glucose (IG) measurements were compared with blood glucose (BG) measurements obtained using a validated portable glucometer. The influence of changes in metabolic variables (ß-hydroxybutyrate, pH, bicarbonate, and lactate) and the effect of BCS and time wearing on sensor performance were evaluated. Accuracy was determined by fulfillment of ISO15197:2013 criteria. RESULTS: Metabolic variables, BCS, and time wearing were not associated with the accuracy of the sensor. Good agreement between IG measurements and BG was obtained both before and after DKA resolution (r = .88 and r = .93, respectively). Analytical accuracy was not achieved, whereas clinical accuracy was demonstrated with 100% and 99.6% of results in zones A + B of the Parkes consensus error grid analysis before and after DKA resolution, respectively. CONCLUSIONS AND CLINICAL IMPORTANCE: Changes in metabolic variables, BCS, and time wearing do not seem to affect agreement between IG and BG. Despite not fulfilling the ISO requirements, the FGMS provides clinically accurate estimates of BG in dogs with DKA.

Lispro insulin and electrolyte supplementation for treatment of diabetic ketoacidosis in cats.

BACKGROUND: Intravenous continuous rate infusion (IVCRI) of lispro at a starting dose of 0.09 U/kg/h and the use of 0.9% sodium chloride (NaCl) for fluid resuscitation in cats with diabetic ketoacidosis (DKA) have not been reported. Protocols for correction of electrolyte deficiencies in cats with DKA are lacking. OBJECTIVES: To characterize the use of IVCRI lispro at an initial dose of 0.09 U/kg/h and the use of NaCl for resuscitation. Explore protocols for electrolyte supplementation in cats with DKA. ANIMALS: Twelve cats with DKA enrolled from the cat population of a university hospital. METHODS: Randomized, controlled, blinded study. Six cats were randomized into each group, the lispro insulin treatment group (LITG) and regular insulin treatment group (RITG). All cats received IVCRI fluid resuscitation with NaCl. Solutions with higher than previously published electrolyte concentrations were used to treat electrolyte deficiencies. RESULTS: The median time to blood glucose (BG) concentration <250 mg/dL was significantly shorter in the LITG (median 7 hours, 2-10 hours) than the RITG (median 12.5 hours, 8-20 hours; P = .02). Two cats had nonclinical hypoglycemia (BG = 40 mg/dL). The most rapid change in 157 measurements of corrected sodium concentrations was 0.7 mmol/L/h. Low concentrations of serum sodium, potassium, phosphate, and magnesium were over 3 times more common than above normal electrolyte concentrations, despite supplementation with fluids of high electrolyte concentrations. CONCLUSIONS AND CLINICAL IMPORTANCE: Lispro at a starting dose of 0.09 U/kg/h and NaCl administered for fluid resuscitation are safe and effective for treatment of DKA in cats.

Loose-control of diabetes mellitus with protamine zinc insulin in cats: 185 cases (2005-2015).

This study evaluated the outcome of cats with diabetes mellitus treated with a loose-control approach using protamine zinc insulin and identified factors that influence the likelihood of remission and survival in these cats. A total of 185 client-owned domestic cats were followed until death, lost to follow-up, or the end of the 11-year study. These cats were treated primarily basing insulin dose adjustments on clinical response. Patient records were used to examine factors suspected of influencing success of diabetes management. The remission probability was 56.2%. Survival time ranged from 0 to 3808 days with a median of 1488 days. Recent pre-diabetic corticosteroid use, lower mean blood glucose concentration during treatment, and lower mean insulin dose significantly increased the likelihood of remission. A low-carbohydrate diet, occurrence of remission, lack of diabetic ketoacidosis at diagnosis, lower mean blood glucose value during treatment, and lower blood glucose value at diagnosis were significantly associated with increased survival time.

Contrôle relâché du diabète sucré à l'aide de l'insuline au zinc de protamine chez les chats : 185 cas (2005­2015). Cette étude a évalué les résultats chez les chats atteints de diabète sucré traités à l'aide d'une approche de contrôle relâché ayant recours à l'insuline de zinc de protamine et a identifié les facteurs qui influencent la probabilité de rémission et de survie chez ces chats. Un total de 185 chats domestiques appartenant à des clients ont été suivis jusqu'à la mort, la perte de suivi ou à la fin de l'étude de 11 ans. Une approche de contrôle relâché et d'insuline au zinc de protamine a été utilisée, surtout sur la base des ajustements de la dose d'insuline en fonction de la réaction clinique. Les dossiers des patients ont été utilisés pour examiner les facteurs soupçonnés d'influencer le succès de la gestion du diabète. La probabilité de rémission était de 56,2 %. Le temps de survie s'échelonnait de 0 à 3808 jours avec une médiane de 1488 jours. L'usage récent de corticostéroïdes prédiabétiques, un taux de glycémie moyen inférieur durant le traitement et une dose d'insuline moyenne inférieure augmentaient significativement la probabilité de rémission. Une diète faible en glucides, l'occurrence de la rémission, l'absence de kétoacidose diabétique, une valeur moyenne inférieure de glycémie durant le traitement et une valeur inférieure de glycémie étaient significativement associées à des temps de survie accrus.(Traduit par Isabelle Vallières).

Use of lispro insulin for treatment of diabetic ketoacidosis in cats.

OBJECTIVES: The aim of this study was to evaluate the efficacy and safety of lispro insulin for the treatment of feline diabetic ketoacidosis (DKA). Times to resolution of hyperglycaemia, ketosis and acidosis were compared between cats treated with continuous rate infusion (CRI) of lispro insulin and cats treated with CRI of regular insulin. METHODS: Client-owned cats with naturally occurring DKA, newly diagnosed with diabetes mellitus (DM) or already receiving treatment for DM, were included. Diagnosis of DKA involved the presence of at least two clinical signs consistent with DKA (eg, polyuria/polydipsia, anorexia, severe lethargy, vomiting and dehydration), blood glucose (BG) concentration >13.9 mmol/l (>250 mg/dl), blood beta hydroxybutyrate (BHB) concentration >2.5 mmol/l and venous pH <7.3 or bicarbonate <15 mEq/l. Cats were treated with a standard protocol of an intravenous (IV) CRI of regular insulin (group R) or lispro insulin (group L). The time to resolution of DKA was defined as the time interval from when the IV CRI of insulin began until marked hyperglycaemia (BG >13.9 mmol/l [>250 mg/dl]), ketosis (BHB concentration >1 mmol/l) and acidosis (venous pH <7.3 and/or bicarbonate <15 mEq/l) resolved. RESULTS: Eighteen DKA cases (nine per group) were enrolled into the study. There were no significant differences in the median time to resolution of three variables (hyperglycaemia, ketosis and acidosis) between the two groups. Two cats in group R developed hypoglycaemia during the CRI of insulin. One cat in group L and three cats in group R developed hypophosphataemia, which required phosphate supplementation. CONCLUSIONS AND RELEVANCE: IV CRI of lispro insulin has few side effects and appears to be as effective as IV CRI of regular insulin in the treatment of cats with DKA.

Diabetic ketoacidosis in the cat: Recognition and essential treatment.

Practical relevance: Diabetic ketoacidosis (DKA) is a not uncommon emergency in both newly diagnosed and poorly regulated diabetic cats. When there is a heightened metabolic rate and energy requirement due to concurrent illness, an increase in the release of glucose counter-regulatory hormones causes insulin receptor resistance, lipolysis, free fatty acid release and ketogenesis. This necessitates not only treatment to eliminate the ketosis and control blood glucose, but also investigation of concurrent illnesses. Clinical challenges: A number of metabolic derangements can occur with DKA, requiring a comprehensive diagnostic evaluation, elimination of ketones, careful correction of glucose, electrolyte and acid base abnormalities, and close monitoring. AUDIENCE: Any veterinarian that cares for cats in urgent and emergency situations should understand the pathophysiology of DKA in order to address an individual's clinical signs and metabolic derangements. Evidence base: This review draws evidence from the peer-reviewed literature as well as the author's personal clinical experience.

Blood lactate concentration in diabetic dogs.

Human diabetic patients may have increased lactate levels compared to non-diabetics. Despite the use of lactate levels in critical care assessment, information is lacking for diabetic dogs. Therefore, this prospective cross-sectional clinical study aimed to determine lactate concentrations in 75 diabetic dogs [25 newly diagnosed non-ketotic diabetics, 25 under insulin treatment, and 25 in diabetic ketoacidosis (DKA)], compared to 25 non-diabetic dogs. Lactate levels (mmol/L) were not different among groups (P = 0.20); median and 25th to 75th percentile were 2.23 and P25-75 = 1.46 to 2.83 for controls, 1.69 and P25-75 = 1.09 to 2.40 for newly diagnosed non-ketotic diabetics, 2.27 and P25-75 = 1.44 to 2.90 for dogs under insulin treatment for at least 30 days, and 2.40 and P25-75 = 1.58 to 3.01 for dogs in DKA. Longitudinal studies assessing both isomers (L- and D-lactate) are needed to better elucidate the role of lactate in the pathophysiology of diabetes acid-base status in dogs.

La concentration de lactate de sang chez les chiens diabétiques. Des patients humains avec diabète peuvent présenter augmentation des niveaux de lactate, quand comparés aux non diabetiques. Bien que est utilisé d'évaluer les patients dans un état critique, cette information manque pour les chiens diabétiques. Par conséquent, cette étude clinique s'agit d'une prospective transversale en vue de detérminer les concentrations du lactate en 75 chiens diabétiques [25 au moment du diagnostic, 25 sous traitement à l'insuline et 25 dans l'acido-cétose diabétique (ACD)], par rapport aux 25 chiens non diabétiques. Les niveaux de L-lactate ne différaient pas entre les groupes (P = 0,20). Les valeurs médianes et les centiles 25 % et 75 % étaient de 2,23 mmol/L (P25­75 = 1,46 à 2,83) pour les contrôles, 1,69 mmol/L (P25­75 = 1,09 à 2,40) au diagnostic, 2,27 mmol/L (P25­75 = 1,44 à 2,90) sous traitement à l'insuline pendant au moins 30 jours, et 2,40 mmol/L (P25­75 = 1,58 à 3,01) dans ACD. Des études longitudinales évaluant les deux isomères (L et D-lactate) sont nécessaires pour élucider son rôle dans la physiopathologie et le déséquilibre acide-base chez les chiens diabétiques.(Traduit par Ana Carolina Possas Viana).

A Quick Reference on High Anion Gap Metabolic Acidosis.

High anion gap (AG) metabolic acidoses can be identified by a decrease in pH, decrease in HCO3- or base excess, and an increased AG. The AG represents the difference between unmeasured cations and unmeasured anions; it increases secondary to the accumulation of anions other than bicarbonate and chloride. The most common causes of high AG acidosis are renal failure, diabetic ketoacidosis, and lactic acidosis. Severe increases in concentration of phosphorus can cause hyperphosphatemic acidosis.

Fluid and Electrolyte Therapy in Diabetic Ketoacidosis.

Diabetic ketoacidosis is a dynamic disease that requires regular reassessment of an affected patient. Typical treatment regimens include crystalloid fluid therapy, insulin, and supplementation of dextrose, phosphorus, and potassium. This article presents an approach to and considerations for treatment of a diabetic ketoacidotic dog or cat.

Pancreatic Lipase Immunoreactivity in Serum of Dogs with Diabetic Ketoacidosis.

BACKGROUND: Diabetic ketoacidosis (DKA) is a relatively common endocrine disorder in dogs and is routinely associated with concurrent pancreatic injury. OBJECTIVES: The aims of this study were to determine the prevalence of pancreatic injury in dogs with DKA based on measurement of pancreatic lipase immunoreactivity in serum (PLI); compare demographic, clinicopathologic, and ultrasonographic findings in dogs with and without evidence of concurrent pancreatic injury; determine the impact of pancreatic injury on duration of hospitalization and short-term outcome. ANIMALS: One hundred and nineteen dogs with DKA with or without concurrent pancreatic injury. METHODS: Retrospective study. Dogs with DKA were divided into three groups on the basis of PLI results: positive for pancreatic injury (PLIpos ), negative for pancreatic injury (PLIneg ), and not tested (PLIna ). Demographics, clinicopathologic test results, findings on abdominal ultrasonography (AUS), duration of hospitalization, and short-term outcome were compared between the three groups. RESULTS: Based on serum PLI activity, 45 dogs (73%) with DKA had evidence of concurrent pancreatic injury. Median total carbon dioxide was significantly lower in the PLIpos dogs compared to the PLIneg dogs. There was fair agreement (κ = 0.26) between serum PLI activity and AUS. Evidence of pancreatic injury was not associated with significantly longer periods of hospitalization (PLIpos median 6 days, range 4-7 days, PLIneg median 4 days, range 3-6 days) and did not influence short-term outcome (PLIpos failure to survive to discharge 11/45, 24%, PLIneg failure to survive to discharge 2/17, 12%). CLINICAL IMPORTANCE: Concurrent pancreatic injury is common in dogs with DKA, but did not affect prognosis in this population of dogs.