Digestion & Metabolism 2: Diabetic Ketoacidosis

Question 1

DIABETIC KETOACIDOSIS (DKA)….

is a ____ form of diabetes mellitus

causes EXCESS ___-___ that result in ____ and SEVERE ____ ___ that can even be ____-___

Answer 1

COMPLICATED form

causes EXCESS KETO-ACIDS that result in ACIDOSIS and SEVERE ELECTROLYTE ABNORMALITIES that can even be LIFE-THREATENING

Question 2

DKA tends to develop in ____ animals that are VERY ___

why? (give 5 steps)

Answer 2

DIABETIC, SICK

why?
1. CONCURRENT ILLNESS to DIABETES

2. causes STRESS
3. release of GCC (counter-regulatory hormone)
4. causes INSULIN RESISTANCE (persistent hyperglycemia)
5. without INSULIN, causes KETO-ACID PRODUCTION (no glucose in cells)

Question 3

5 common CONCURRENT diseases that can cause DKA?

Answer 3

1. HEPATIC LIPIDOSIS
2. CHRONIC RENAL FAILURE
3. ACUTE PANCREATITIS
4. BACTERIAL or VIRAL infections
5. NEOPLASIA

Question 4

treatment with ___ may help INCREASE/DECREASE risk of DKA

Answer 4

INSULIN, DECREASE risk of DKA

Question 5

what ketone is detected on URINE DIPSTICK?

what ketone is detected on KETONE METER?

Answer 5

URINE DIPSTICK = ACETOACETONE

KETONE METER = D-BETA-HYDROXYBUTYRATE

Question 6

KETONE BODY SYNTHESIS starts from WHAT molecule?

how is this molecule initially made?

what hormones should be HIGH vs. LOW in regards to BLOOD GLUCOSE?

Answer 6

KETONE BODY SYNTHESIS starts from ACETYL-CoA

initially made from FAT BREAKDOWN because NOT ENOUGH GLUCOSE

hormones..
INSULIN = LOW
COUNTER-REGULATORY HORMONES = HIGH

Question 7

in DIABETES MELLITUS, there is ____ SYNTHESIS of ____-____ due to DECREASED ____ and INCREASED ____ resulting in EXCESS ____ ____ ____

Answer 7

EXCESS, ACETYL-CoA, INSULIN GLUCOAGON, FATTY ACID OXIDATION

Question 8

4 CONTRIBUTING FACTORS to METABOLIC ACIDOSIS?

Answer 8

1. formation of KETO-ACIDS
2. VOMITING
3. DEHYDRATION
4. RENAL HYPOPERFUSION

Question 9

DKA can include clinical signs that include CHRONIC ____ ___, such as (2)…

DKA predisposed in WHAT cat breed?

Answer 9

DIABETES MELLITUS…
1. PU/PD
2. POLYPHAGIA

DKA predisposed in SIAMESE

Question 10

if we see DKA and ABDOMINAL PAIN, can indicate WHAT SECONDARY CAUSE?

Answer 10

PANCREATITIS

Question 11

TRUE/FALSE

we can see NEUROLOGIC ABNORMALITIES with DKA, such as DULL MENTATION, RECUMBENT & PLANTIGRADE STANCE

Answer 11

TRUE

Question 12

what 3 CBC ABNORMALITIES can we find in DKA?

what is NORMAL in A CERTAIN SPECIES?

Answer 12

CBC ABNORMALITIES…
1. ANEMIA –> 50% of dos
2. LEFT SHIFT NEUTROPHILIA
3. THROMBOCYTOSIS in DOGS

CATS can have NORMAL PLATELETS

Question 13

on CHEMISTRY, DOGS tend to have HIGH ____ IN DKA, while in CATS…

what 2 other values are usually also elevated in DOGS?

what 1 other value is usually elevated in CATS?

Answer 13

DOGS TEND TO HAVE HIGH ALP IN DKA, but cats have NORMAL ALP because NO STRESS-INDUCED ALP ISOENZYME

can also have HIGH ALT/AST

cats = AST

Question 14

3 UA findings in DKA?

Answer 14

1. GLUCOSURIA
2. KETONURIA –> EMERGENCY
3. PROTEINURIA possible

Question 15

4 changes in ELECTROLYTES in DKA?

Answer 15

1. LOW K
2. LOW Mg
3. LOW P
4. LOW Na

Question 16

why does HYPOKALEMIA occur in DKA?

4 common clinical signs?

what MEDICAL INTERVENTION can WORSEN HYPOKALEMIA?

Answer 16

because if ACIDOTIC, can EXCHANGE CELLS TAKING IN H+ for EXCRETING K+ IN URINE

4 common clinical signs?
1. MUSCLE WEAKNESS
2. PARALYSIS
3. RESPIRATORY DEPRESSION
4. CARDIAC ELECTRIC CONDUCTION ABNORMALITIES

can make hypokalemia worse by GIVING FLUIDS

Question 17

3 CAUSES for HYPONATREMIA?

Answer 17

1. activation of Na/H EXCHANGER to CORRECT ACIDIC pH (H+ in, Na excreted out)
2. OSMOTIC DIURESIS
3. HYPERLIPIDEMIA

Question 18

2 SIGNIFICANT CLINICAL SIGNS from HYPONATREMIA…

Answer 18

1. CEREBRAL SWELLING
2. ALTERED MENTAL STATUS

Question 19

2 CAUSES for HYPOMAGNESEMIA? (low Mg)

Answer 19

1. INSUFFICIENT DIETARY INTAKE of Mg
2. INCREASED RENAL EXCRETION of Mg

Question 20

TREATMENT of DKA…

what is MOST IMPORTANT treatment we can do?

SECOND MOST important treatment?

THIRD MOST important? how must this be done? (2)

Answer 20

MOST IMPORTANT = DO IV FLUIDS!

SECOND-MOST important = CORRECT ELECTROLYTE ABNORMALITIES

THIRD MOST important = CORRECTION OF HYPERGLYCEMIA
1. must be done SLOWLY to AVOID EXTREME OSMOTIC SHIFTS
2. give GLUCOSE every 4-6 HOURS

Question 21

ELECTROLYTE ABNORMALITIES in DKA tend to develop WHEN?

Answer 21

within FIRST 48 HOURS of TREATMENT

Question 22

once we start administering IV FLUIDS to DKA patient, how will GLUCOSE levels change?

Answer 22

will start to LOWER BLOOD GLUCOSE CONCENTRATIONS