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.

A case of hyperglycemic hyperosmolar syndrome in a pug dog.

An 8-year-old spayed female pug dog that had recently been diagnosed with pancreatitis was brought to a veterinary clinic with polyuria, polydipsia, and seizures. The dog was diagnosed with hyperglycemic hyperosmolar syndrome, a rare complication of diabetes mellitus. The dog was hospitalized and was administered intravenous fluids and insulin therapy, and clinical signs improved.

Un cas de syndrome hyperosmolaire hyperglycémique chez une chienne carlin. La chienne carlin femelle stérilisée âgée de 8 ans qui avait récemment reçu un diagnostic de pancréatite a été amenée dans une clinique vétérinaire avec une polyurie, une polydipsie et des convulsions. La chienne a été diagnostiquée avec le syndrome hyperosmolaire hyperglycémique, une complication rare du diabète sucré. La chienne a été hospitalisée et a reçu des fluides intraveineux et une insulinothérapie, et les signes cliniques se sont améliorés.(Traduit par Dr Serge Messier).

Hyperglycemic hyperosmolar state in a chimpanzee (Pan troglodytes).

A 19-year-old female chimpanzee (Pan troglodytes) presented for cachexia, acute weakness, hyporexia, icterus, and polyuria. The animal was diagnosed with a hyperglycemic hyperosmolar state, which is a well-recognized syndrome in diabetic humans that is rarely diagnosed in animals. This case documents an important and likely under-reported syndrome in non-human primates.

Retrospective evaluation of hyperosmolar hyperglycemia in 66 dogs (1993-2008).

OBJECTIVES: To clinically characterize a large group of dogs with the hyperosmolar hyperglycemic state (HHS) and to determine whether 2 HHS subgroups, dogs with hyperosmolar ketonuric (HK) diabetes mellitus (DM) and dogs with hyperosmolar nonketonuric (HNK) DM were clinically different from one another. DESIGN: Retrospective study. Records of 1,250 diabetic dogs that were examined between January 1993 and July 2008 were reviewed in order to identify dogs with HHS. Inclusion required a calculated serum osmolality ≥325 mOsm/kg, with or without ketonuria. SETTING: University teaching hospital. ANIMALS: Sixty-six dogs with HHS including 34 dogs with HK, 25 dogs with HNK, and 7 dogs with unclassified HHS. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: HHS was diagnosed in 5% of dogs with DM. HK and HNK dogs were similar to one another in regard to most historical, physical examination, and clinicopathologic variables as well as outcome. Sixty-two percent of dogs with HHS survived to discharge from the hospital. Poor outcome of HHS dogs was associated with abnormal mental status (P = 0.03) and a low venous pH (P = 0.045). Dogs with HK were significantly more likely to have acute pancreatitis (P = 0.046), higher body temperature (P = 0.006), higher WBC count (P = 0.01), and a shorter duration of clinical signs (P = 0.02) compared to dogs with HNK. Dogs with HNK had significantly higher BUN and creatinine concentrations (P = 0.0002 and P = 0.008, respectively) and higher calculated osmolality (P = 0.001) compared to dogs with HK. CONCLUSIONS: HHS is a rare condition in which poor outcome is associated with abnormal mental status and low venous pH. Among dogs with HHS, the subgroup of dogs with HK has significantly more acute pancreatitis, shorter duration of clinical signs, and higher body temperature and WBC count compared to dogs with HNK, whereas dogs with HNK have more azotemia and higher calculated osmolality compared to dogs with HK.

Diabetic emergencies in small animals.

Diabetic ketoacidosis and hyperglycemic hyperosmolar syndrome are two serious and potentially life-threatening complications of diabetes mellitus. Understanding pathophysiology is crucial to the proper management of veterinary patients with these disorders. This article reviews the biochemical alterations contributing to these conditions, and discusses traditional and controversial management strategies.

Hyperosmolar hyperglycaemic syndrome in a dog resulting from parenteral nutrition overload.

A dog treated for a pancreatic abscess inadvertently received 1800 ml of hyperosmolar solution within a two hour period. Blood glucose reached 44 mmol/litre and the plasma osmolality was estimated to be more than 334 mOsm/litre. Lipaemia was severe and persisted for several days. The dog developed nausea, vomiting, depression, severe hyperglycaemia, polyuria, glucosuria and hypokalaemia. These symptoms were consistent with a hyperosmolar hyperglycaemic syndrome. Treatment with insulin and intravenous fluid rapidly corrected the hyperglycaemia, electrolyte imbalances and water deficits. The dog recovered and no long-term sequelae were observed.

Emergency therapy of diabetic crises: insulin overdose, diabetic ketoacidosis, and hyperosmolar coma.

Three types of diabetic crises occur: insulin overdose, diabetic ketoacidosis, and hyperosmolar coma. Neurologic signs may accompany each of these syndromes, and each must be differentiated quickly by the emergency clinician so that an appropriate treatment plan can be initiated. The basic goal is to restore metabolic derangements and to stabilize the patient so that it can then be managed more routinely as an uncomplicated diabetic.

Hyperosmolar non-ketotic diabetic coma in the nonhuman primate: a first report.

Diabetes mellitus was diagnosed in an aged bonnet macaque (Macaca radiata). Six months later the monkey was found comatose. Laboratory findings of extreme hyperglycemia, hyperosmolality, and glycosuria without ketonuria were consistent with a diagnosis of hyperosmolar, non-ketotic diabetic coma (NKC). Further laboratory studies disclosed very low levels of immunoreactive insulin and depressed free fatty acid values. Growth hormone and cortisol levels were within normal limits.