Iowa State University's College of Veterinary Medicine student Taylor Morrison presents a case of Diabetic Ketoacidosis in a feline patient as seen at Iowa Veterinary Specialties.

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