Page 24 - Basic Monitoring in Canine and Feline Emergency Patients

Blood glucose chances for a positive outcome and provides infor-
mation to the owner as to the degree of interven-
A variety of diseases and situations can lead to
VetBooks.ir hypoglycemia and hyperglycemia. See Table 1.8 for tion and cost their pet may require. Therefore,
having the capability to identify the presence of
the most common causes of each condition as well
as associated clinical signs. ketones is critical to success not only to make an
Anorexia is unlikely to be a cause of hypoglyce- early diagnosis, but also to make repeated assess-
mia in an adult animal unless they are severely ments to monitor response to therapy.
cachectic, so hypoglycemia should prompt further Diabetic patients with low to trace ketones, no
investigation beyond mild-to-moderate anorexia. acidosis, and who are still eating and drinking can
In contrast, in juveniles, especially toy breeds, often be managed as outpatients with adjustments
poorly developed liver function can cause these to insulin and treatment of underlying disease con-
patients to become hypoglycemic within hours of ditions (e.g. urinary tract infection, pancreatitis)
decreased food intake. that may have led to the development of ketosis.
Animals that initially present with normal BG Patients with significant ketone levels causing aci-
can become hypoglycemic quickly in the face of dosis often require more extensive supportive care
progressive disease. Serial monitoring of BG in that is best provided in a hospital environment.
patients with underlying conditions such as sepsis Healthy dogs generally have 3-HB levels
or hepatic failure is therefore recommended, and <0.32 mmol/L. A 3-HB level cutoff above
rechecking BG in any patient who has had an acute 3.8 mmol/L has been suggested by Duarte et al.
change in hemodynamic or neurological status that (2002) as having the best predictive value for diag-
cannot be easily explained by other causes is nosis of DKA in dogs. In cats, a normal reference
warranted. limit of <0.11 mmol/L has been reported, with all
cats with DKA in a study by Weingart (2012) hav-
ing 3-HB concentrations >3.8 mmol/L. However,
cats with other disease processes such as hepatic
Ketones
lipidosis can also have elevated ketone levels,
As indicated previously, the presence of ketones is which have been reported to be as high as 2.78 in
most important in diabetic animals in whom there one study by Gorman et al. (2016). Therefore,
is concern for DKA. Early identification and thera- while severe elevations in ketones are almost
peutic intervention in cases of DKA increases the always associated with DKA, mild-to-moderate

Table 1.8. Clinical signs and causes of hypoglycemia and hyperglycemia.
Hypoglycemia Hyperglycemia

Clinical signs Abnormal behavior Increased thirst
Mental dullness Increased urination
Weakness Weight loss
Hypersalivation Polyphagia
Tremors Dehydration
Seizures Alterations in mental status
Death Coma
Common underlying causes Sepsis Diabetes mellitus
Juvenile and toy breeds Pheochromocytoma
Insulinoma Hyperadrenocorticism
Paraneoplastic Iatrogenic dextrose administration
Hypoadrenocorticism Administration of dextrose containing
Insulin overdose fluids
Toxins: (Xylitol, ethylene glycol ) Drugs: glucocorticoids
Hepatic insufficiency Parenteral nutrition
Spurious (sample storage) Stress hyperglycemia/excessive
Severe starvation catecholamines
Glycogen storage diseases

16 P.A. Johnson