Canine diabetic ketosis-ketoacidosis: A retrospective study of 23 cases (1997-2013)

Abstract

The purpose of this retrospective study was to describe the historical and clinical findings, the clinicopathological abnormalities, the occurrence and nature of concurrent diseases, the treatment and outcome of 23 dogs with diabetic ketosisketoacidosis (DK-DKA). Inclusion criteria consisted of the presence of clinical signs suggestive of diabetes mellitus (DM) along with persistent hyperglycemia, glycosuria and ketonuria during the first 24 hours of hospitalization. In nineteen dogs (83%) DM had not been previously diagnosed. Common presenting complaints were polyuria/polydipsia (100%), partial or complete loss of appetite (87%), depression (87%), vomiting (65 %) and weight loss (30 %). The most frequent physical examination findings included dehydration (61%), depression (61%), hypotrichosis-alopecia (39%), palpable cranial abdominal organomegaly (26%), pendulous abdomen (26%), lesions compatible with superficial pyoderma (17%), thin and hypotonic abdominal skin (17%), and hypothermia (17%). The most important clinicopathological abnormalities, apart from hyperglycemia, glucosuria, and ketonuria, included anemia (48%), leukocytosis (39%), increased activities of alkaline phosphatase (100%), lipase (56%) and alanine aminotransferase (52%), hypertriglyceridemia (90%) and hypercholesterolemia (84%). Also, 12 dogs demonstrated hypokalemia on admission or during hospitalization. A concurrent disease was identified in 74% of the cases while 26% had two or more comorbidities. The latter included pancreatitis (30%), urinary tract infections (17%), superficial pyoderma (17%), urolithiasis (13%) and hyperadrenocorticism (13%). Twenty two dogs were treated with short-acting insulin (regular or lispro) and one with intermediate-acting (lente) insulin, whereas intravenous fluid therapy was instituted in 78% of them with potassium and phosphorus supplementation in 65% and 9%, respectively. Seventeen (81%) dogs survived to be discharged, three (13%) died during hospitalization, one (4%) was euthanized and on two (9%) occasions owners declined hospitalization after the first 24 hours due to financial constrains or a poor prognosis. Mean duration of hospitalization for the survivors was 5.7 ± 2.4 days, mean time to resolution of ketonuria was 4.2 ± 1.9 days and median time of rapid-acting insulin administration was 4 days (range 2-8 days).