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Diabetes Ketoacidosis (DKA) - A Complication of Diabetes in Cats and Dogs

Unfortunately, as veterinarians, we are seeing an increased prevalence of diabetes mellitus in dogs and cats. This is likely due to the growing prevalence of obesity (secondary to inactive lifestyle, a high carbohydrate diet, lack of exercise, etc.). You're probably wondering if you just had a dog or cat diagnosed with diabetes mellitus—what do you do? First, we encourage you to take a look at these articles for an explanation of the disease:

This article will teach you about life-threatening complications that can occur as a result of the disease; specifically, a life-threatening condition called diabetes ketoacidosis (DKA) so that you know how to help prevent it.

What is DKA?

When diabetes goes undiagnosed or difficult to control or regulate, the complication of DKA can occur. DKA develops because the body is so lacking in insulin that the sugar can’t get into the cells — resulting in cell starvation. Cell starvation causes the body to start breaking down fat in an attempt to provide energy (or a fuel source) to the body. Unfortunately, these fat breakdown products, called “ketones,” are also poisonous to the body.

Symptoms of DKA

Clinical signs of DKA include the following:

  • Weakness

  • Not moving (in cats, hanging out by the water bowl)

  • Not eating or complete anorexia

  • Vomiting

  • Excessive thirst and urination (clear, dilute urine)

  • Large urinary clumps in the litter box (anything bigger than a tennis ball is abnormal)

  • Weight loss (most commonly over the back), despite an overweight body condition

  • Obesity

  • Flaky skin coat

  • Excessively dry or oily skin coat

  • Abnormal breath (typically a sweet “ketotic” odor)

  • Diarrhea

In severe cases DKA can also result in more significant signs:

  • Abnormal breathing pattern

  • Jaundice

  • Abdominal pain (sometimes due to the secondary problem of pancreatitis)

  • Tremors or seizures

  • Coma

  • Death

What can cause DKA?

When DKA occurs, it’s often triggered by an underlying medical problem such as an infection or metabolic (organ) problem. Some common problems that we see with DKA include the following:

  • Pancreatitis

  • Urinary tract infection

  • Chronic kidney failure

  • Endocrine diseases (e.g., hyperadrenocorticism [when the body makes too much steroid], or hyperthyroidism [an overactive thyroid gland])

  • Lung disease (such as pneumonia)

  • Heart disease (such as congestive heart failure)

  • Liver disease (such as fatty changes to the liver)

  • Cancer

Diagnosing DKA

While diagnosing DKA is simple, by looking at the blood sugar levels of dogs and cats and by measuring the presence of these fat breakdown products in the urine or blood, treatment can be costly (running between $3-5000). A battery of tests and diagnostics need to be performed, to look for underlying problems listed above, and treatment typically requires aggressive therapy and 24/7 hospitalization.

Treatment of DKA

Treatment, typically, is required for 3-7 days, and includes the following:

  • A special intravenous catheter called a “central line” (placed to aid in frequent blood draws)

  • Aggressive intravenous fluids

  • Electrolyte supplementation and monitoring

  • Blood sugar monitoring

  • A fast acting or ultra fast acting insulin, regular or Lispro, typically given intravenously or in the muscle

  • Blood pressure monitoring

  • Nutritional support (often in the form of a temporary feeding tube)

  • Anti-vomiting or anti-nausea medication

  • Antibiotics

  • Long-term blood sugar monitoring and a transition to a longer-acting insulin

Thankfully, with aggressive supportive care, many patients with DKA do well as long as pet parents are prepared for the long-term commitment (including twice-a-day insulin, frequent veterinary visits to monitor the blood sugar, and the ongoing costs of insulin, syringes, etc.).

Preventing DKA

By following your veterinarian’s guidelines and recommendations you can help regulate and control your pet’s diabetic state better and monitor your pet carefully for clinical signs. For example, if your pet is still excessively thirsty or urinating frequently despite insulin therapy, they are likely poorly controlled and need an adjustment of their insulin dose (of course, never adjust your pet’s insulin or medications without consulting your veterinarian).

When in doubt remember that the sooner you detect a problem in your dog or cat, the less expensive that problem is to treat. If you notice any clinical signs of diabetes mellitus or DKA, seek immediate veterinary attention. Most importantly, blood glucose curves (when a veterinarian measures your pet’s response to their insulin level) often need to be done multiple times per year (especially in the beginning stages of diabetes mellitus).

If you have any questions or concerns, you should always visit or call your veterinarian.

Related reading:


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dog health, cat health

Pet Poison Prevention: Kitchen Toxins

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It’s amazing (yet scary) how many common food items in our kitchen are poisonous to our pets! Some of these food items, while safe to you, may cause serious problems if ingested by our dogs and cats. Here is the list of kitchen products that the veterinarians at Pet Poison Helpline recommend keeping away from pets.

Chocolate

Chocolate comes in many different forms, such as: white, dark, milk, semi-sweet, baker’s and cocoa powder. Each type of chocolate has a different toxicity level. Baker’s, cocoa, dark and semi-sweet chocolates are toxic in much smaller amounts than milk or white chocolate due to the greater concentration of theobromine and caffeine. A mild toxic dose of chocolate can cause agitation/hyperactivity, vomiting and diarrhea. Moderate toxicity can cause tachycardia (increased heart rate) and severe toxic levels can cause seizures. Chocolate stays in the stomach for several hours after ingestion, so symptoms may not show for up to 12 hours after ingestion. Chocolate stays in the system for a long period of time, so if symptoms occur, they can last potentially 72-96 hours.

Xylitol (common in sugar-free chewing gum)

Xylitol is a sugar alcohol and is gaining popularity in sugar-free foods, oral care products, and dietary supplements. Common products that contain xylitol are gum, toothpaste, sugar-free candy, chewable vitamins, and melatonin supplements. It is also sold in bulk for baking. Although safe for humans, xylitol can cause hypoglycemia (low blood sugar) and liver failure in dogs that ingest toxic amounts. The symptoms can be very rapid, occurring within 30 minutes to 2 hours after ingestion. Common symptoms of xylitol poisoning include vomiting, weakness, lethargy, difficulty walking (ataxia) and seizures. Dogs are the most susceptible pet species to xylitol toxicity.

Grapes / raisins / currants

Grapes, raisins and toxic currants (Vitis species) can cause acute kidney failure in dogs. There is no known toxic dose for these fruits so any ingestion should be considered potentially toxic. Common symptoms include vomiting, diarrhea, lethargy, anorexia (not eating), weakness, and decreased urine output. Symptoms show within 12-24 hours.

Caffeine

Caffeine poisoning, while not as common as chocolate poisoning, can occur with ingestion of products such as coffee, tea, chocolate, certain drugs such as migraine medications, and caffeine or diet pills. Caffeine poisoning can cause restlessness, hyperactivity, vomiting, panting, tachycardia (increased heart rate), weakness, diarrhea, and heart symptoms can occur 1-2 hours after ingestion and can last for 12-36 hours. Fatality is common when dogs ingest caffeine pills.

Fatty scraps

While it is tempting to feed your pet scraps from the table, fatty food scraps can cause stomach upset and is a risk for pancreatitis in pets. Pancreatitis is a condition where the pancreas becomes inflamed. Symptoms of pancreatitis include vomiting, abdominal pain, loss of appetite (anorexia), lethargy, and diarrhea. Some dog breeds are more prone to pancreatitis such as miniature schnauzers, miniature poodles, and cocker spaniels. Older and overweight dogs can also be prone to pancreatitis, but with an ingestion of fatty foods, any dog can be susceptible.

Onions / garlic / chives / leeks / shallots

Ingestion of these foods in large enough quantities can cause oxidative hemolysis, which is defined as the destruction of the red blood cells, causing anemia. Common symptoms of toxicity can include but are not limited to: lethargy, pale mucous membranes, abdominal pain, vomiting, diarrhea, increased heart rate, and increased breathing rate. The onset of symptoms can be anywhere from 24 hours after ingestion to several days. The symptoms can potentially last for 10-20 days. Dogs, cats, cattle and horses can be affected.

Macadamia nuts

Macadamia nuts are a common snack for people but can be toxic to dogs. Macadamia nuts contain up to 80% oil and 4% sugar which can increase the risk for pancreatitis (high fat). In toxic quantities, the nuts can also cause neurological signs such as weakness, ataxia (difficulty walking), tremors, hyperthermia (increased temperature), and joint stiffness. Symptoms of neurological poisoning can be witnessed within 3-6 hours and can last for 24-36 hours. Dog breeds more predisposed to pancreatitis (e.g., miniature schnauzers, miniature poodles, cocker spaniels, obese dogs, etc.) may be at higher risk but all dogs may be susceptible to pancreatitis.

Unbaked yeast bread dough

Any bread made with baker’s yeast can be toxic if the unbaked bread dough is ingested. When bread dough is rising, the yeast consumes sugars in the dough and in turn produces ethanol and carbon dioxide. The carbon dioxide forms bubbles in the dough making it rise. Ingestion can cause ethanol (alcohol) toxicity as well as obstruction of the stomach, stomach bloat and/or stomach torsion. Common symptoms from ethanol toxicity include acting “drunk”, sedation, ataxia (difficulty walking), hypoglycemia (low blood sugar), hypothermia (low temperature), GI distress, respiratory depression, and coma. Bloat and stomach torsion are more common in deep-chested dog breeds such as the Great Dane, German Shepherd, Irish Setter, Gordon Setter, Weimaraner, Saint Bernard, Standard Poodle, and Bassett Hound, however, any breed of dog could be at risk. Common symptoms of bloat include abdominal distension, pawing, restlessness, and unproductive retching. Symptoms can occur one hour after ingestion but can be delayed. Symptoms can last 24-36 hours and surgical intervention may be needed to remove the dough.

Alcohol

Alcohol or ethanol toxicity can occur when an animal ingests alcoholic beverages, alcohol-based hand sanitizer, yeast bread dough, etc. Common symptoms from ethanol toxicity include acting “drunk”, sedation, ataxia (difficulty walking), hypoglycemia (low blood sugar), hypothermia (low temperature), GI distress, respiratory depression, and coma. Symptoms have a rapid onset, within 30 – 90 minutes, and can last 24-36 hours.

Table salt

Ingestion of salt can cause sodium poisoning (hypernatremia). Hypernatremia is an increase of sodium concentrations in the blood. Common symptoms of salt toxicity include vomiting, diarrhea, polydipsia (increased drinking/thirst), ataxia (difficulty walking), tremors, and seizures. Symptoms can occur within 30 minutes to 4 hours. Animals can also be at risk for salt toxicity when they ingest homemade play-doh, salt ornaments, baking soda, de-icing products, and other salt-containing products.


Even with the best planning and intentions, our pets will occasionally be exposed to toxic substances in the kitchen. If you suspect your pet has had a toxic exposure call your veterinarian or Pet Poison Helpline immediately as time is of the essence. It is not always safe to induce vomiting or administer other home remedies. Seek counsel before taking action.


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