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Healing & Alternative Health
Dr. Carson's Holistic Animal Care:
SIGNS OF AGING IN THE DOG AND CAT, PART XXIII:
Organs of the Abdomen: Organs of the Abdomen: Diseases of the Pancreas: Diabetic Ketoacidosis
by Kathleen M. Carson, D.V.M
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Diabetic ketoacidosis (DKA) is a life-threatening form of diabetes mellitus (DM). It develops most often in the dog or cat with undiagnosed Type I diabetes mellitus. There are usually multiple causative factors. This means that dogs or cats who develop DKA usually have not only DM but also other disease(s).
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.
As I wrote in my June 2006 column, animals with DM have large amounts of glucose in their blood streams, but, due to an absolute deficiency of insulin or factors which make it impossible for the insulin which is present to do its job (insulin resistance), the glucose is unable to get into the cells, where it is needed as fuel. The animal’s body thinks it is starving and starts to break down its own body tissue 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.
As I wrote in my June 2006 column, animals with DM have large amounts of glucose in their blood streams, but, due to an absolute deficiency of insulin or factors which make it impossible for the insulin which is present to do its job (insulin resistance), the glucose is unable to get into the cells, where it is needed as fuel. The animal’s body thinks it is starving and starts to break down its own body tissues to supply more fuel. If this “starving in the midst of plenty” condition goes on for a long enough time, DKA results.
A DKA dog or cat is dehydrated, often severely. The dehydration is caused in part by what’s called osmotic diuresis: the kidneys get rid of the excess blood glucose; as the glucose is excreted, it pulls with it water as well as the electrolytes sodium (Na), potassium (K), calcium (Ca), phosphorus (P), and magnesium (Mg). Also, as the DKA develops, the DKA animal feels sicker and sicker, drinking and eating less; in addition, he usually starts to vomit and have diarrhea. Thus, there is excess water (and electrolytes) going out and less-than-usual water (and electrolytes) coming in.
The second major factor in DKA is a condition of excess acidity in the body. As the body’s proteins, fats, and carbohydrates are broken down in an attempt to correct “starvation”, chemicals called ketone bodies (KBs) are formed. KBs are strong acids, and, as their numbers build up, eventually a potentially life-threatening condition called metabolic acidosis comes about.
As the body attempts to get rid of the ketones in the urine, they pull even more water and electrolytes out of the body, thus contributing to a worsening vicious cycle.
The signs of decreased appetite, vomiting and diarrhea, “acetone” breath (smells like nail polish remover) weight loss, weakness, and, sometimes, seizures or coma obviously will alert you to the fact that your animal is very sick and needs to see her veterinarian. (If the DKA is caught early enough, the signs you would see are the same as that of a non-DKA diabetic - though probably more pronounced - excess thirst/urination, weight loss in spite of an excess appetite.)
Your veterinarian will want to hospitalize your DKA dog or cat, even if her symptoms are mild, because DKA is such a serious, potentially life-threatening disease and because the treatment is complex and is based on how the patient responds to the treatment as time goes by. If your animal is severely weak and dehydrated and having seizures or is comatose there is no question about hospitalization.
Blood tests, urinalysis (UA), and urine culture will be necessary to make a diagnosis and to rule in/out concurrent disease. If not enough information is obtained from these tests, then X-rays and, possibly, ultrasound (U/S) may be needed.
What would lab tests show if your animal has DKA? Listed below are many of the abnormalities which may be found in a DKA patient:
Blood test results:
*Hyperglycemia (high blood glucose) - it can range between 200 mg/dl to 1000 mg/dl (normal = 80-120 mg/dl).
*Acidosis - the blood arterial pH can range from 6.6 to 7.2; a pH of < 7.0 is life-threatening.
*Elevated WBC (white blood cell count) - Found where there is inflammation, infection, stress.
*Lower-than-normal levels of electrolytes: Na, K, Ca, P, Mg.
*Elevated PCV (packed cell volume) or Hct (hematocrit); these are measures of the % of the total blood volume taken up by the RBCs (red blood cells). This is an indication of dehydration.
*Elevated TP (total protein) - this is another indicator of dehydration.
*Elevated BUN (blood urea nitrogen) and creatinine - these could signal renal (kidney) failure, or just be another sign of dehydration.
*Elevated liver enzymes (e.g., SGPT/ALT, Alk. Phos. etc.) - this can reflect true liver disease or be caused by severe dehydration.
*Elevated lipase or amylase - a sign of pancreatitis.
Urinalysis, urine culture:
*Ketonuria - ketones in the urine
*Glucosuria - glucose in the urine
*Proteinuria - proteins in the urine, due to renal disease and/or UTI.
*WBCs, RBCs, protein, bacteria - definite indications of UTI.
Next month I’ll write about the treatment of DKA.
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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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