Diabetic ketoacidosis is caused by a lack of insulin or an insufficient amount of insulin.  Since the lack of insulin means that glucose in not able to be used, the body searches for a new source of energy.  In this condition, the diabetic breaks down body fat (lipolysis) to use as energy. During lipolysis, waste products called ketones are produced. Ketones are eliminated in the urine and through the lungs. Under normal conditions, the body can tolerate and eliminate ketones. But in diabetic ketoacidosis, fats are being broken down at such a high rate that the body can not eliminate the ketones fast enough and they build up in the blood. In high amounts, ketones are toxic to the body. They cause the acid-base balance to change and serious electrolyte and fluid imbalances result.

Some of the signs of ketoacidosis include
  • polyuria
  • polydipsia
  • lethargy
  • anorexia
  • weakness
  • vomiting
  • dehydration
  • There will probably be ketones in the urine (ketonuria)
  • The breath may have a sweet chemical smell similar to nail polish remover.  However, some owners have said that even during documented ketoacidosis, their pet's breath did NOT have any unusual odor.

Mildly ketoacidotic animals can be alert and well hydrated. After your pet is stabilized, your pet can return home and be treated with proper diabetes management techniques including insulin therapy, diet, and exercise.

"Sick" ketoacidotic animals require intensive medical management in the vet hospital. This is a life-threatening emergency that requires complex medical management and monitoring. It may take several days for the animal to be out of danger. Treatment involves injections of regular insulin, intravenous fluids, electrolytes, and frequent monitoring of blood glucose, blood chemistry, and fluid and electrolyte balance. Possible complications of ketoacidosis include depletion of potassium and phosphate, hypoglycemia, fluid accumulation in the brain and lungs, renal failure, heart failure, and death. As you can see, this is an extremely serious situation that requires immediate medical management by a veterinarian.

Although serious, ketoacidotic animals can recover with little or no side-effects.

Robert and Zama's experience with ketoacidosis.

"We" meaning Zama Q. Ubiquitous Catt, has had one 'lab verified' encounter with ketoacidosis.

His symptoms at home: Throwing up every few hours, no interest in food for over 24 hours, did not want to be petted or handled, looked and acted depressed, but *Not* stumbling or disoriented. For a while he was interested in drinking, but after about 24 hours, lost interest in even that.

Actions Taken:

I stewed for awhile about taking him to Emergency (a Sunday Evening of course...) He just didn't seem hypoglycemic (vision still good), but I couldn't see how he could be hyper since he hadn't eaten in over 24 hours. I did try twice to get a blood sample from his footpads, but he threw-up and screamed each time, so I gave up. Another hour or two went by. He hardly moved at all, just sat like an egg (sitting on all 4 paws), and continued to refuse petting or sugar-water by mouth.

At 7pm I caved in and went to the Emergency Clinic. A quick blood test was done, and they announced his bg was 1200+, had a slightly high temperature, and very depressed. The doctor reached the 'depressed' diagnosis because Zama did not resist the thermometer at all - not a sound. Apparently a cat that makes no fuss about the proverbial stick up the *** is a depressed cat - sounds fair to me. I was about to call the doctor a liar when he announced Zama was hyperglycemic, but quickly realized he had the test results so I backed off.

Zama was kept overnight. His neck was shaved in a very wide band, a catheter inserted into the jugular vein on the neck, and then given a continuous drip of Ringers Lactate with potassium. Via the catheter he was given 1 unit of regular insulin each hour until his BG dropped below 150 (this took about 6 hours), and then a glucose mixture was added to the Ringers Lactate solution. When the BG went back over 250, he was given 1/2 unit of regular insulin. Blood was sampled about every 1/2 hour (also via the catheter).

A lab analysis of the initial blood sample showed very high ketones and BG 1500+, thus the doctor said Zama had indeed been suffering from ketoacidosis.

He spent the following day at the vet clinic being monitored, but the catheter plugged up, and they had to resort to vein draws from the legs. By 3pm they were out of usable veins, so they sent him home. He still had the jugular catheter attached, and lots of tubing at that point. He looked awful to most I suppose, but I was so happy he was alive and home. In 24 hours I went from the saddest to the happiest I have ever been.

The catheter was removed the following day, and I then began a week of giving him Ringer's Lactate at home once a day. Talk about big needles - yikes! I really had to take a deep breath and assemble all my courage - but as you know, anything for our SugarCat's.

This all happened last Labor Day (1998), and so now 3 months later all is pretty well. Zama has full vision, leaps like a rocket, scrapes the wall, bangs the cabinets - all healthy cat activities. He is just over 11 years old, and has lived 7+ years with diabetes. He has taught me more about resilience and being tough than I ever thought possible. I don't know how one small critter can have so much courage and will to survive.

And now the rest of the story...

Several days after the crisis, Zama was missing and I combed the neighborhood. About 3/4 a block away, a neighbor arrived home and saw me calling for Zama. "Is your cat missing?" he asked. "He was in our garage last weekend and ate all our cat's food - maybe he's there now". Sure enough, Zama had gotten stuck inside the neighbor's garage again - hoping for more food. A bit more discussion, and I found that our neighbor had given Zama several bowls full of "Generic" low-quality grocery store food the day the whole crisis had begun. "He looked hungry" my neighbor said. I bit my tongue, and didn't mention that his providing Zama with a junk lunch had nearly cost Zama his life. And me another month's mortgage payment. Well, I guess this is what neighbors are for - to help us out.

Yes, I did learn from this. The next day I made up "Do Not Feed Me" notecards for all the neighbors, and then went door to door to all houses within 2 blocks of our home. Should have done this 7 years ago I suppose - but it was a never a problem - until last Labor Day.

I should also mention that the Emergency Clinic doctor also told me initially "Zama is very very ill - the chances are not too good for him". I replied "Yes, I understand, but if Zama could tell you just one thing right now, it would be 'Don't treat me like I'm gonna die - Treat me like you expect me to live - because I'm one tough cat". The doctor smiled a warm smile, shook his head slowly up and down, and said "Yes, if he's made it seven years with diabetes, he probably will make it. We'll do our very best". And he did, and the whole clinic did too. I stopped by every 2-3 hours to drop off baked treats for the staff, and while I was there to of course say 'Hi' to Zama and bring him some clothes with my scent.

Like a lot of things with diabetes, the situation scared me, but I also learned from it. If there is anything else I can offer to help others, just let me know. I am grateful to you all. -- Contributed by Robert.


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Updated October 2000
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