Page 2501 - Cote clinical veterinary advisor dogs and cats 4th

1248 Insulin Resistance Ketonuria

Insulin Resistance Keratoconjunctivitis Sicca (KCS)
VetBooks.ir Causes of Insulin Ineffectiveness or Insulin Resistance Immune-mediated adenitis: most common (dogs)

Breed predisposition
in Diabetic Dogs and Cats
Congenital anomaly
Caused by Insulin Therapy Drug-induced (transient KCS): general anesthesia, topical anesthesia, atropine
Inactive insulin Drug toxicosis (transient or permanent KCS): sulfa drugs, phenazopyridine,
Diluted insulin aminosalicylic acid, etodolac
Improper administration technique Iatrogenic:
Inadequate dose Removal of the gland of the third eyelid
Somogyi effect Idiopathic
Inadequate frequency of insulin administration Infectious agents:
Impaired insulin absorption, especially Ultralente insulin Canine distemper virus
Antiinsulin antibody excess Feline herpesvirus
Caused by Concurrent Disorder Metabolic disease (hypothyroidism, hyperadrenocorticism, diabetes mellitus)
Acromegaly (cat)* Chronic blepharoconjunctivitis (chemosis/ascending infection from lacrimal gland,
Congestive heart failure causing lacrimal ductal obstruction)
Chronic inflammation, especially pancreatitis or bowel Neurogenic
Chronic kidney disease Radiation therapy for nasal or intracranial neoplasms
Diabetogenic drugs, including glucocorticoids* Trauma to orbit or eye
Diestrus (bitch)*
Glucagonoma (dog) Modified with permission from Bonagura J: Kirk’s Current veterinary therapy XII: small animal practice,
Philadelphia, 1995 Saunders, p 1232.
Hepatobiliary disease
Hyperadrenocorticism*
Hyperlipidemia
Hyperthyroidism (cat)
Hypothyroidism (dog)
Infection, especially of oral cavity and urinary tract
Neoplasia
Obesity Ketonuria
Pancreatic exocrine insufficiency
Pheochromocytoma
Progesterone excess (endogenous or exogenous)*
*Marked insulin resistance Diabetes mellitus/diabetic ketoacidosis
Modified from Feldman E, Nelson R: Canine and feline endocrinology and reproduction, ed 3, St. Starvation
Louis, 2004, Saunders. Lactation
Pregnancy
Fever
Renal glucosuria
Severely carbohydrate-restricted diet
Glycogen storage disease
Extreme exercise
False-positive: hematuria, hemoglobinuria, aciduria, highly concentrated urine
Iron Abnormalities

Serum [Iron] TIBC Ferritin
Normal N N N
Hemolytic anemia ↑ ↑ ↑
Anemia of chronic disease N or ↓ N or ↓ N or ↑
Iron deficiency (= chronic ↓ N or ↑ ↓*
blood loss)
Inflammation ↓ ↓ ↑
Glucocorticoid treatment/ ↑ N —
excess
Iron overload/toxicosis ↑ ↓ ↑
Artifact (sample ↑ (serum Fe > TIBC) ↓ or N —
contamination)
*Concurrent inflammation or other disorders may raise ferritin level into normal range.
N, Normal; TIBC, total iron-binding capacity (equivalent to saturated transferrin concentration).

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