Diabetic ketoacidosis (DKA) is a serious metabolic disorder in cats caused by insufficient insulin, leading to ketone production, acidosis, and systemic illness. It commonly affects diabetic patients and presents symptoms like increased drinking, urination, vomiting, and dehydration. Immediate medical treatment is necessary, which includes hospitalization, fluid therapy, insulin administration, and long-term management of diabetes mellitus.

1. Diabetic Ketoacidosis (DKA) in
Cats

2. What is DKA?
• DKA is a metabolic disorder that occurs when the body
doesn’t produce enough insulin, or the tissues don’t
respond to the insulin.
– Insulin is responsible for transporting sugar into cells for use as energy.
Without insulin, the cells can’t perform normal functions and are essentially
“starved.”
• Increased production of hormones that have anti-insulin
effects such as glucagon, cortisol, and epinephrine, can
exacerbate the insulin deficiency or insulin resistance.

3. What is DKA?
• The liver responds by using fatty acids as an energy
source. The fats are converted into ketones (ketoacids).
This can lead to acidosis, electrolyte imbalances, and
signs of systemic illness.
• DKA is a life-threatening condition that requires
immediate medical attention!

4. Which Patients Develop DKA?
• Patients with diagnosed Diabetes Mellitus
• Patients with undiagnosed Diabetes Mellitus
• Patients with poorly managed or untreated Diabetes
Mellitus

5. Symptoms & Physical Exam Findings
• Increased drinking and urination
• Increased appetite
• Vomiting and/or diarrhea
• Weakness
• Anorexia and/or weight loss
• Dehydration
• “Fruity odor” to the breath (from the ketones)
• Enlarged liver
• Rapid breathing

6. Diagnosis of DKA
• Clinical Signs and Physical Exam
• Bloodwork
– Hyperglycemia (high glucose in the blood)
– Ketones in the blood
– Metabolic acidosis (low body pH)
– Electrolyte abnormalities
• Urinalysis
– Glycosuria (glucose in urine)
– Ketones in the urine
• The majority of patients with DKA also have a concurrent illness such as
pancreatitis or a urinary tract infection

7. Treatment of DKA
• Immediate hospitalization
• Fluid therapy, often with additional electrolytes added
• A few hours after starting fluid therapy, insulin is given to
help slowly lower the blood glucose concentration
• Broad-spectrum antibiotics to treat concurrent infection, or
anti-nausea medications may also be necessary
• After stabilization, patient will be started on subcutaneous
insulin that will be given long-term to control Diabetes
Mellitus
• Long-term change to high fiber diet

8. Prognosis for DKA
• Depends upon the progression of the disorder.
• Fair to guarded, with concurrent illness
leading to guarded prognosis

9. DKA Case Example: “Peanut”
• 7-year old neutered male domestic
shorthair cat
• Presented with a two-day history of
lethargy, anorexia, weight loss, and
increased drinking and urination.
• Peanut’s referring veterinarian had
seen Peanut earlier in the day, and lab
work showed glucose in the blood
and urine: both signs of potential
Diabetes Mellitus

10. “Peanut”
• Physical Exam Findings:
– Dehydrated
– Mild decrease in muscle mass
– Tense abdomen
– Poor haircoat
• Recommended hospitalization, abdominal radiographs,
bloodwork, and blood glucose monitoring.

11. “Peanut” Diagnostics
• Bloodwork: Hyperglycemia (high blood glucose),
acidemia (low blood pH), low potassium,
sodium, and chloride (electrolytes)
• Urine ketones: high
• Abdominal radiographs: no significant findings

12. “Peanut” Treatment
• Hospitalization
• Fluids with supplemental potassium
• Anti-nausea medications
• Insulin was started after Peanut became
re-hydrated.
• Blood glucose measurements were taken every
2 hours.
• High-Fiber Diet

13. “Peanut” Goes Home!
• Ketones in the urine resolved
• Electrolytes and blood glucose concentrations
stabilized
• Peanut began eating well
• Started on subcutaneous insulin that will continue to
be administered by Peanut’s owner at home
• Peanut’s owners were instructed to feed him twice a
day, and give insulin after he finishes each meal

14. Conclusion
• Patients that survive an episode of Diabetic
Ketoacidosis will need long-term care for
their Diabetes Mellitus
• DKA is a serious metabolic disorder. Please
bring your pet to the veterinarian
immediately if you notice any of the listed
symptoms