The information contained in this article is provided for educational purposes only and is not intended to replace veterinary advice. Please consult with your vet for further information.
What is a DKA?
A DKA is the result of dehydration, high blood glucose levels, and the inability of cells to access energy from glucose. This situation leads to the breakdown of fat and muscle cells for fuel which causes acid ketones as a by-product. Please see the information under Ketones for more information about ketones.
When a DKA occurs, a number of things happen:
• Blood glucose cannot be used, so builds up and spills over into the urine.
• Ketones, caused by the breakdown of fat and muscle cells for fuel as cells cannot access the glucose, build up causing ketosis (ketones present in the urine).
• Severe dehydration occurs as the body tries to rid itself of the excess glucose and ketones, leading to increased urination.
• Acids build up in the blood, leading to a metabolic acidosis.
• The level of ketones in the urine pulls in electrolytes to neutralize them using the difference in acidity……
• …… as a result potassium levels in particular, but also other electrolytes such as phosphorous can become severely depleted.
A DKA can cause a severe electrolyte imbalance and dehydration, which can lead to coma and death if not treated immediately.
Treatment for DKA
There are three main issues that need to be dealt with that require immediate veterinary assistance:
1. It is essential to reduce blood glucose levels.
2. Re-hydration via fluid therapy is also essential.
3. Electrolyte imbalances must be corrected.
1. Blood Glucose levels
In order to reduce BG levels, a very fast acting insulin is usually needed. Common fast acting insulins are:
• Nova Rapid (in most countries outside of the US)
• Novalog (USA)
For certain cats, using a intermediate acting insulin such as NPH (also known as Humulin N in North America or Humulin I in Europe), or Caninsulin (Vetsulin in the US) may help.
Vet protocols for using the very fast or faster acting insulin types are usually very conservative. If your cat requires need of these after leaving the vet, please post on Introductions & Questions to ask for assistance with dosing. Several Senior Members do have experience with using them and can help you.
Do not try and dose faster acting insulin at home without help and advice from those that have experience with them.
Most cats suffering from a DKA are severaly dehydrated. Your vet will normally have used IV fluids to re-hydrate your cat. The fluids will also be used to add electrolytes and bring them back to normal levels.
3. Electrolyte Imbalances
In order to deal with the imbalances of electrolyte levels, your vet will add and adjust amounts via the IV fluids. It is difficult to find the correct balance: bringing one electrolyte back to normal numbers can result in an imbalance with another. Correcting the other can throw the first back off again.
• Potassium is the electrolyte that is the most commonly depleted with a DKA. Low potassium levels can lead to muscle weakness and heart problems.
• Low levels of phosphorous may also often occur, leading to weakness, anemia and even seizures.
• Low magnesium levels can aggravate low potassium levels, leading to cardiac problems.
It is essential that your vet either has in-house lab equipment or access to a near-by place that has (for example, a local hospital) in order to closely monitor the electrolyte levels. On-going testing is necessary to monitor and adjust the different electrolyte levels and correct the imbalances.
Once your cat is back home after a DKA
There are three essential things to do once you are able to bring your cat home:
1. Keep your cat’s BG levels down.
2. Make sure your cat is well hydrated.
3. Test for ketones.
1. Keeping BG levels down
It is extremely important to keep BG levels at least under renal threshold (225-250/12.5-13.9), and preferably in or as close to normal range as possible (45-130/2.5-7.2): doing so will reduce the risk of ketones developing and the possibility of another DKA occurring.
Experienced Members will help you use your cat’s usual insulin and/or fast-acting insulin depending on the situation. Do not attempt to use fast-acting insulin yourself without vet or forum support.
2. Keeping your cat well hydrated
It is important to make sure your cat stays well hydrated once back with you. Adding extra water to his food will help.
Some cats may need subcutaneous (SubQ) fluids. SubQ fluids are not difficult to give – if you are able to dose your cat insulin, you can give SubQ fluids! Please see the article in the Knowledge Centre on SubQ Fluids for more information: Giving SubQ fluids .
3. Checking for ketones
It is very important that you keep a close eye on the possible development of ketones, which could lead to another DKA. If you have a meter that tests for blood ketones, do use it. Blood ketones show earlier than urine ketones, and you will be able to react more quickly. Please see the information in Ketones on how to test.
Further Information on DKA
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