Ketoacidosis is a very serious complication of diabetes. It is an illness that we do sometimes diagnose in both dogs and cats. However, it should not be confused with ketosis, which occurs during starvation or in certain types of low carbohydrate diets in people, and is not in itself harmful. Ketoacidosis is a severe and potentially life-threatening condition that requires urgent treatment by a veterinary surgeon. 

In healthy animals, glucose (sugar) is used as the main energy source by most organs in the body. When there isn’t enough glucose available, the liver breaks down fat stores into an alternative fuel called ketone bodies or ketones. Low levels of ketones can provide energy and are helpful in situations such as starvation.

However, in diabetics, the production can run out of control and result in excessively high levels. This is termed ketoacidosis.

Ketoacidosis is a complication of uncontrolled diabetes. Confusingly, diabetes is generally characterised by high blood glucose levels; however, because of a lack of the hormone insulin, this glucose is trapped within the bloodstream. As a result, organs such as the brain are unable to access the trapped glucose to use as fuel. This triggers the overproduction of ketones. The high ketone levels make the blood too acidic and results in serious illness.

Animals with poorly controlled diabetes, causing high blood sugar levels, are more likely to develop ketoacidosis. Certain underlying conditions can contribute to this.

In cats, these can include infections (such as urinary tract infections), kidney failure, pancreatitis, liver problems and sometimes cancers. Affected dogs are often found to be suffering from conditions such as pancreatitis, Cushing’s disease (a condition where the body produces too much steroid hormone) or urine infections in addition to their diabetes. Any illness or severe stress can make it more likely that ketoacidosis will develop. 

What are the signs to watch out for?

Signs that an animal has developed ketoacidosis may include;

  • Excessive thirst and increased urination
  • Lethargy
  • Dehydration
  • Decreased appetite
  • Fast breathing
  • Vomiting or diarrhoea

Affected pets can also develop heart arrhythmias. Some people might notice an odd sweet smell, like pear drops, on their pet’s breath. Untreated ketoacidosis can cause animals to fall unconscious and even lead to death in severe cases. 

Your vet can diagnose the condition using a combination of blood and urine tests. This usually shows high glucose levels and the presence of ketones. Other conditions must be ruled out, and your vet will want to check for complications and underlying conditions that may have caused ketoacidosis to develop. 

How can it be treated?

Most affected pets will need intensive treatment usually as an inpatient at a veterinary hospital. Treatment includes intravenous fluids (a drip) and short-acting insulin treatment, as well as supportive treatments such as potassium supplements.

The aim is to treat their dehydration, reduce high blood sugar levels and correct electrolyte abnormalities. Animals need very close monitoring with regular blood tests so their medications can be adjusted appropriately to give them the best chance of recovery.

How can it be prevented?

To try and prevent ketoacidosis from developing in your diabetic pet it is important that you follow the instructions for treating their diabetes carefully and attend regular check-ups at your veterinary clinic to monitor how well their blood sugar is being controlled. In addition, your vet may recommend tests for some of the underlying conditions, such as urinary tract infections, that can lead to poorly controlled diabetes.

Certain medications, such as steroids can also affect blood sugar levels and make the development of ketoacidosis more likely. Always make sure your veterinary surgeon is aware that your pet is diabetic when they are prescribing any new treatments. 

It is vitally important that if you suspect your pet could be suffering from ketoacidosis you should seek veterinary advice urgently. The condition can progress very quickly and without the right treatment might endanger your pet’s life.

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DMSD Vet Manual – Diabetes in pets and companion animals