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Ask a Vet: Can Dogs Survive Diabetic Ketoacidosis DKA?

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Dogs with Diabetic Ketoacidosis

Whether dogs survive diabetic ketoacidosis or not, depends on various factors. It's an unfortunate occurrence that sometimes dog owners are unable to identify that a dog is diabetic and this may lead to progression of the disease, potentially culminating into a case of diabetic ketoacidosis. In order to better understand this condition, it's important to take a closer look into what happens when a dog develops diabetic ketoacidosis, what causes it and how it impacts the dog's body. Veterinarian Dr. Ivana Vukasinovic provides details about this condition and what ultimately helps dogs survive diabetic ketoacidosis, along with some statistics.

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Diabetic ketoacidosis in dogs can cause a distinctive smell in their breath.

What is Diabetic Ketoacidosis in Dogs? 

DKA or diabetic ketoacidosis is a serious metabolic disorder affecting dogs that occurs as a form of complicated diabetes mellitus (DM). Diabetes mellitus is caused by the lack of insulin (either by lack of insulin production or inactivity of insulin receptors), and besides many functions of insulin, the most important one is glucose uptake by the cells for energy.

Without insulin, the cells cannot access glucose, thereby causing them to undergo starvation. The body then provides an alternative source of energy in a form of ketone bodies by breaking down the adipocytes and releasing free fatty acids. Using the fat tissue combined with the inability to utilize glucose usually leads to weight loss presentation despite having a great appetite.

There are three ketone bodies: acetone, acetoacetate, and beta-hydroxybutyrate, and although acetone is neutral the other two are anions of moderately strong acids, when the production of ketone bodies exceeds the ability of the body to utilize them, they build up in the dog's bloodstream, causing the pH to drop, resulting in metabolic acidosis.

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Ketone bodies have a characteristic smell, which can easily be detected in the breath of dogs in ketoacidosis. It is often described as fruity or like nail polish remover.

Predisposing factors that can lead to this condition are infections (bacterial urinary infection for example), acute pancreatitis, hyperadrenocorticism, trauma, or stress. No breed is particularly predisposed, and no age is more or less predisposed, although diabetic ketoacidosis in dogs usually does not affect puppies under the age of 8 months.
Most dogs with diabetic ketoacidosis are newly diagnosed or undiagnosed diabetics.

Symptoms of Ketoacidosis in Dogs 

Diabetic ketoacidosis in dogs can cause chilling.

Diabetic ketoacidosis in dogs can cause chilling.

Symptoms of diabetic ketoacidosis in dogs include symptoms of DM, a combination of acute DKA symptoms with chronic or untreated DM. Dogs that present with DKA may have already been diagnosed for DM or they are just starting to show symptoms of diabetes mellitus.

Symptoms of diabetic ketoacidosis in dogs include weight loss, polydipsia (increased drinking), polyuria (increased urination), abnormal appetite. These symptoms are usually followed by anorexia, lethargy, and vomiting which means that the patient most likely already have metabolic acidosis developed.

Other symptoms include hypothermia (feeling cold), rough hair coat, depression changed breathing and ketone breath. The patient can have only one or more symptoms.

The most common laboratory findings for dogs with DKA are glucosuria (excretion of glucose into the urine), hyperglycemia ( excess of glucose in the bloodstream over 200 mg/dL), ketonuria (large amounts of ketone bodies in the urine) and metabolic acidosis.

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As diabetic ketoacidosis in dogs is a serious and life-threatening condition, proper and fast diagnosis is crucial.

One of the factors that must be monitored and evaluated is kidney function, as kidney function may decrease as a consequence of changes in urine, pH, and overall health status.

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Fluid therapy is paramount to help dogs survive diabetic ketoacidosis.

Can Dogs Survive Diabetic Ketoacidosis DKA?

Can dogs survive diabetic ketoacidosis? It depends. Whether dogs survive diabetic ketoacidosis or not, depends on various factors, the most fundamental one being prompt treatment. Following is info on treatment and how it helps dogs survive diabetic ketoacidosis, along with some statistics by Dr. Ivana.

Treatment of patients with DKA includes fluid therapy as the most important part of treatment for restoring volume and perfusion, followed by correcting electrolyte abnormalities.

Electrolytes must be monitored frequently as the dog may be hyperkalemic (potassium level in a dog's blood that's higher than normal) at the start of the treatment and then may become hypokalemic (potassium level in a dog's blood that's lower than normal) after therapy has begun.

Fluid therapy is commonly in the form of 0.9% sodium chloride or Ringer's solution, while hypokalemia is treated by IV infusion of potassium.

The third step is the insulin therapy, which has the effect on lowering both glucose and ketone concentrations which can improve, if not reverse, metabolic acidosis in dogs. Insulin therapy is usually the third step after the above mentioned two, which allows fluid therapy to correct dehydration, electrolytes imbalance, but mainly hyperglycemia.

The timing of including insulin in the therapy should be decided by the veterinarian. At the moment, regular insulin is recommended for canine DKA therapy. This medicine can be administered as an IV or intramuscular (IM). There are 3 protocols for a therapy: intramuscular injections hourly, intramuscular injections every 4 to 6 hours or constant-rate insulin infusion.

When IV regular insulin is administered as an IV, blood glucose is measured every 2 hours. When insulin is administered IM, it is given every hour, and blood glucose is measured every hour. The initial dose of IM therapy is 0.2 U/kg regular insulin IM, followed by 0.1 U/kg regular insulin IM 1 hour later. Treatment with IM regular insulin is continued with 0.05 U/kg/hr, 0.1 U/kg/hr, or 0.2 U/kg/hr if blood glucose drops more by than 75 mg/dl/hour, between 50-75 mg/dl/hour, or by less than 50 mg/dl/hour, respectively.

Can dogs survive diabetic ketoacidosis? Let's take a look at some statistics to gain a better insight. Almost 70 percent of treated animals survive to be discharged from the clinic. Different underlying coexisting conditions can affect prognosis. Up to 10 percent of dogs can have recurring episodes of DKA. Careful monitoring of dogs with diabetic ketoacidosis plays a most important role in treating patients with DKA.

Owners should be advised to check every change in appetite, water intake, and increased urination, changes in weight or stance, breathing, or neurological problems like confusion and report to the vet. Diabetic ketoacidosis is a medical emergency and a life-threatening condition, so preventing it is important.

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