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Healing & Alternative Health
Dr. Carson's Holistic Animal Care:
SIGNS OF AGING IN THE DOG AND CAT, PART XXV:
Organs of the Abdomen: Organs of the Abdomen: Diseases of the Pancreas: Diabetic Ketoacidosis: Treatment
by Kathleen M. Carson, D.V.M
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Last month I wrote about Diabetic Ketoacidosis (DKA), a very serious, sometimes fatal, condition which usually comes about in an animal who has had undiagnosed diabetes for long enough that harmful changes in his body have come about. Very often, an animal with DKA also has other types of disease(s) along with the diabetes.
Since DKA is so serious, if your dog or cat is diagnosed with it, your veterinarian will hospitalize your animal.
Even though most animals with DKA are seriously ill by the time they're diagnosed, there are some who, luckily, aren't that bad off. These are called healthy ketoacidotic diabetic animals. A 'healthy' DKA patient is bright and alert. She is eating but has very high levels of glucose and ketones in her blood and urine. In spite of being in fairly good shape, a healthy DKA animal is usually hospitalized, too, since there is a chance she could worsen, and your veterinarian will want to monitor her until her blood glucose (BG) is at, or close to, normal, and there are no more ketones in her blood and urine.
Her hospital treatment will consist of multiple daily injections of Regular (short-acting) insulin. Her BG and urine will be monitored several times during the day to make sure the glucose and ketone levels are coming down. (If not, the dose of the Regular insulin will be increased.)
If she's dehydrated, she'll be put on fluids. Your veterinarian will also run tests to see if there are diseases present in addition to the diabetes. Again, as I wrote last month, 'Common underlying diseases in the DKA dog include: urinary tract infection (UTI), Cushings disease (overactive adrenal glands), pancreatitis, cancer, and hypothyroidism. Common underlying diseases in the DKA cat include: pancreatitis, cholangiohepatitis (inflammation/infection of the liver and bile ducts), inflammatory bowel disease, hepatic lipidosis, chronic kidney failure, infections, and cancer.' If one or more of these is discovered, then treatment(s) will be instituted for these.
When her BG is at, or close to, normal, and there are no more ketones in her blood or urine, and treatment for concurrent diseases is instituted, your kitty will be sent home on a longer-acting insulin, dietary changes, etc, as discussed in my October 2006 column.
Treatment for a sick DKA patient is much more involved, depending on the number of things which have gone "out of whack" in his body, and how many concurrent diseases he has. Remember, he will be severely dehydrated, have electrolyte imbalances, especially sodium (Na), potassium (K), calcium (Ca), phosphorus (P), and magnesium (Mg). Due to the ketones in his blood, his body will be very acidic. He'll be in shock, and he will be very depressed and weak. Any or all of these conditions can be fatal.
He will need intensive care over the next several days if he is to survive. Multiple tests need to be done and then repeated to find out all the things which are abnormal, and then monitor them to make sure they're corrected and that no new abnormal conditions occur.
Intravenous (IV) fluids will be started right away to begin to correct both the dehydration and the electrolyte imbalances, as well as low blood pressure (hypotension), if present.
As the dehydration, electrolyte imbalances, and hypotension begin to be corrected, treatment with insulin will be started. Like with the healthy DKA patient, the insulin of choice is the short-acting Regular insulin. Small amounts of this insulin will be given intra-muscularly (IM) every hour until your animal's BG is under 250 mg/dl (normal BG = 80 - 120 mg/dl); at that point, some dextrose (a sugar) will be added to the IV fluids to ensure that the BG doesn't go too low. The frequent injections of the insulin will be continued; the dose of insulin probably will be increased as time goes by, depending on how your animal's BG levels respond.
Some experts recommend putting the insulin in the fluids so the animal gets a continuous infusion of this hormone rather than giving multiple, frequent IM injections.
Of course, treatment(s) must also be given for any concurrent diseases/conditions which have contributed to the development of DKA. Also, new problems, such as cerebral edema (excess fluid in the brain), hypoglycemia(low blood sugar), hypokalemia (low blood potassium), and hypophosphatemia (low blood phosphorus) can develop during the DKA animal's stay in the hospital. These may come about because DKA is so complex, that, in spite of the best efforts, things can go 'out of whack' in the opposite direction as attempts are made to correct the original abnormal conditions. It's very tricky to fine-tune the treatment of a seriously ill DKA patient.
If your seriously ill DKA animal responds to treatment (there is a 30-40% mortality rate with DKA), then she will be sent home with a longer acting insulin, dietary changes, and treatment(s) for any concurrent disease(s).
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Dr. Kathleen Carson, DVM
Veterinarian & Author
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Dr. Carson received her Doctor of Veterinary Medicine degree from the University of California at Davis in 1968. She's been a small animal practitioner (dogs and cats ) for all the years since, except for a short stint at the San Diego Zoo when she first graduated.
She belongs to the American Veterinary Medical Association and the American Holistic Veterinary Medical Association.
Since 1974 she's lived and practiced in the South Bay Area near Los Angeles. She started the area's first house call practice in 1976 and the first pet crisis/loss group in 1989. The human-animal bond is of special interest to her.
She started exploring complementary veterinary medicine in 1987. Her practice became 100% holistic in 1996. She utilizes acupuncture, herbs, supplements, Bach Flower Remedies, homeopathic remedies, nutrition and medications for her patients in her practice.
She's currently taking a leave of absence from her house call practice due to health reasons but continues to do phone consultations and to write.
E-mail:
Critterhlr@aol.com
website:
http://www.holistic
vetconsult.com
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