Felix, a 10 year old male neutered cat, presented to North Coast Veterinary Specialist and Referral Centre for management of Diabetic Ketoacidosis. He had a long history of weight loss in which he lost approx. 20% of his bodyweight. He presented to the emergency vets at Animal Emergency Services Sunshine Coast, collapsed and weak with severe electrolyte and metabolic disturbances.
Diabetic Ketoacidosis is a life-threatening complication when a second disease compromises a patient with diabetes mellitus. Common secondary diseases are Urinary Tract Infections, Pancreatitis, Hyperadrenocorticism and Hepatic Lipidosis, but any disease can be a trigger.
After a full diagnostic work up including biochemistry, blood gas analysis, urinalysis, CBC, chest radiographs and abdominal ultrasound, Felix was diagnosed with DKA triggered by hepatic lipidosis.
Hepatic lipidosis is caused by rapid weight loss in cats as the liver tries to remove the fat from the blood stream by incorporating it into hepatocytes. Felix had an elevated ALT and Bilirubin with a marked diffuse, hyperechoic hepatomegaly on ultrasound.
Ketoacidosis occurs when a decrease in nutrition plane results in rapid muscle catabolism and ketones are produced as an energy source but accumulate faster than they can be utilised.
Felix had severe electrolyte disturbances with hypokalaemia, hyponatraemia, hypochloraemia and hypophosphataemia. He was hyperglycaemic with glucosuria.
He received intensive care with a continuous rate infusion of crystalline insulin, aggressive electrolyte supplementation (including phosphorus), and critically, nutrition support via an oesophagostomy feeding tube. Reversing the catabolic state requires insulin supplementation beyond the normalisation of blood glucose levels, so a glucose infusion was added as needed to allow ongoing insulin administration. Feeding was instituted to fully replace Felix’s energy needs over 3 days and was maintained for supplemental feeding at home for 2 weeks. Felix responded slowly but steadily to treatment and was discharged after 7 days in hospital on twice daily glargine insulin. His feeding tube was removed after 2 weeks and he has now returned to a healthy body condition, with a normal liver size and is full of energy.
Felix will now be managed as a ‘well’ diabetic with insulin and dietary therapy for life.
Although there is the possibility of cats going into ‘remission’ from diabetes, Felix had most likely already had a stage of remission earlier in his disease course and is not expected to come off insulin.