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Special challenges of the diabetic ketoacidotic cat (Proceedings)

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Apr 01, 2010

I. Pathophysiology
      A. Ketone bodies: acetoacetate, beta hydroxybutyrate, acetone
      B. Oxidation of free fatty acids
      C. Mobilization of fatty acids from adipose tissue
      D. Shift from fat synthesis to fat oxidation in the liver
      E. Relative/absolute deficiency in insulin
      F. Mitigating factor
           a. elevation in glucose counter-regulatory hormones, especially glucagon
           b. glucagon:insulin ratio
           c. metabolic acidosis
           d. elevations in plasma free fatty acids and amino acid concentrations
      G. Hyperketonuria enhances osmotic diuresis and electrolyte loss into the urine
      H. Severe volume depletion
      I. Severe acidosis
      J. Pre-renal azotemia

II. Clinical presentation
      A. Previously diagnosed diabetes mellitus
      B. Previous clinical signs of diabetes mellitus
      C. Anorexia
      D. Vomiting
      E. Weight loss
      F. Tachypneic
      G. Tachycardic
      H. Lethargy
      I. Depression/obtundation
      J. Poor perfusion, weak pulses, pale mm
      K. Hypotension

III. Initial Diagnostic Assessment
      A. PCV/TS/AZO/DEX
      B. Na, K, UA (dipstick and S.G.), serum ketones
      C. Osmolality, blood gas
      D. CBC, Chemistry, Urinalysis, Urine culture


Potassium Replacement
IV. Diagnosis
      A. Hyperglycemia
      B. Glucosuria
      C. Ketonemia
      D. Ketonuria

V. Clinical Pathologic Abnormalities
      A. Elevated WBC left shift if pancreatitis or underlying infection
      B. Elevated liver enzymes
      C. Icterus in some cats
      D. Azotemia, pre renal
      E. Sodium concentration normal/low
      F. Potassium concentration normal/low
      G. Acidosis
      H. Bacteriuria, pyuria