Diabetes with Ketone Bodies in Dogs

Studies show that female dogs (particularly non-spayed) are more prone to DKA, as are older canines. Diabetic ketoacidosis is best classified through the presence of ketones that exist in the liver, which are directly correlated to the lack of insulin being produced in the body. This is a very serious complication, requiring immediate veterinary intervention. Although a number of dogs can be affected mildly, the majority are very ill. Some dogs will not recover despite treatment, and concurrent disease has been documented in 70% of canines diagnosed with DKA.

Some dogs who are suffering from diabetic ketoacidosis may present as systemically well. Others will show severe illness. Symptoms may be seen as listed below:

• Change in appetite (either increase or decrease)
• Increased thirst
• Frequent urination
• Vomiting
• Abdominal pain
• Mental dullness
• Coughing
• Fatigue or weakness
• Weight loss
• Sometimes sweet smelling breath is evident
• Slow, deep respiration.

There may also be other symptoms present that accompany diseases that can trigger DKA, such as hypothyroidism or Cushing’s disease.

While some dogs may live fairly normal lives with this condition before it is diagnosed, most canines who become sick will do so within a week of the start of the illness. There are four influences that can bring on DKA:

• Fasting
• Insulin deficiency as a result of unknown and untreated diabetes, or insulin deficiency due to an underlying disease that in turn exacerbates the illness because there is an inadequate amount of insulin being taken
• Dehydration
• Stress hormone levels increasing (i.e. cortisol and glucagon).

It is important to note that concurrent diseases are a factor in DKA as well. Studies show the most common coexisting illnesses are hyperadrenocorticism, bacterial urinary tract infection, and pancreatitis.

Prompt and aggressive treatment is necessary for untreated cases of DKA due to the variety of complications that result from untreated cases. The veterinarian will use various methods to diagnose diabetes with ketones, starting with a complete history of findings as described by you. It is important to relay all symptoms and behavioral characteristics seen of late.

Whether your pet has already been diagnosed with diabetes will be an important consideration for the veterinarian as well. Checking for ketones involves a standard urinalysis. A urine culture is a relevant tool also because urinary tract infections are very common in patients who have DKA.

A thorough blood analysis is essential. The veterinarian will verify if there are reduced serum bicarbonate concentrations and elevated serum glucose concentrations, and check the serum kidney values, pancreatic enzyme measurements, and electrolyte levels. The measurements of venous carbon dioxide and blood gas elevation will be taken.

A liver function test is likely, as is a chest x-ray and an abdominal ultrasound. The veterinarian will listen for a heart murmur and unusual lung sounds. She may find skin abnormalities or cataracts, both common signs of DKA.

The treatment of mild diabetes with ketone bodies will vary from the treatment of a severe case. Often, dogs who have a serious crisis as a result of the ketones will be very ill, and in many instances near death.

A dog who appears healthy or has minimal symptoms can present with high serum glucose and ketones in the urine. Often, the treatment for mild DKA is regular insulin therapy in the form of injections of short-acting insulin to get the serum glucose levels back in order. This may take a few days, but the prognosis is good.

When treating severe DKA, veterinarians must take a more aggressive approach. Of utmost importance is diagnosing and treating any underlying cause that may be adding to the crisis. Dogs in an emergency situation will be hospitalized, generally for a period of five to six days. Aggressive treatment will commence with intravenous fluids, which have been shown to bring rapid improvement to the condition of dogs suffering from DKA. Balancing the electrolyte levels is the second, very important step. Phosphate and potassium supplements are given. The veterinarian may choose to give bicarbonate to correct acid based upset.

Glucose levels will be adjusted gradually. Regular crystalline insulin, which is the shortest acting form, will be given either by injection or intravenously. Administration by intravenous is the chosen method for canines in critical condition. The blood glucose will be measured every two to four hours at treatment onset. The veterinarian will monitor your pet carefully because complications like hypoglycemia, brain swelling, and anemia can occur. Once your dog is stabilized, a longer acting insulin will be given.

Antibiotics may be given to treat infection, even if not yet identified. Drugs may be given to encourage urine volume, with a catheter inserted in order to track more easily urine production. Vital signs will be carefully audited, and often an electrocardiogram is done.

The prognosis for DKA is good, but, of course, depends on if an underlying disease is present and can be treated successfully. It has been reported that many dogs hospitalized with this condition will be able to go home and enjoy a productive life. It must be noted that 70% of dogs have been known to have a recurrence. Therefore, watching for signs of trouble must be part of your pet care regimen. Checking of insulin levels, and communication with your veterinarian on a regular basis will be advised. Your dog should be on a low-fat diet, with high levels of fiber and complex carbohydrates.