Peer-reviewed veterinary case report
Insulin infusion methods for diabetic ketoacidosis in dogs and cats
By Gant, Poppy et al.·Published in Journal of veterinary emergency and critical care (San Antonio, Tex. : 2001)·2024·Department of Emergency and Critical Care, United Kingdom·View original on PubMed →
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Original publication title: Comparison of insulin infusion protocols for management of canine and feline diabetic ketoacidosis.
- Species:
- dog
Plain-English summary
A group of 20 dogs and 16 cats with diabetic ketoacidosis (DKA) were treated with either a fixed-rate or variable-rate insulin infusion to see which method helped them recover faster. Most dogs (95%) showed improvement, but the type of insulin infusion didn't make a difference in how quickly they got better, although those on the fixed-rate infusion spent less time in the hospital. For the cats, only about half recovered, and the study found no significant differences in their outcomes. Overall, while both methods were safe, the fixed-rate infusion didn't speed up recovery for either species.
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Abstract
OBJECTIVE: Describe the use of fixed-rate intravenous insulin infusions (FRIs) in cats and dogs with diabetic ketoacidosis (DKA) and determine if this is associated with faster resolution of ketosis compared to variable-rate intravenous insulin infusions (VRIs). Secondary objectives were to evaluate complication rates, length of hospitalization (LOH), and survival to discharge (STD). DESIGN: Randomized clinical trial (January 2019 to July 2020). SETTING: University veterinary teaching hospital and private referral hospital. ANIMALS: Dogs and cats with DKA and venous pH <7.3, blood glucose concentration >11 mmol/L (198 mg/dL), and β-hydroxybutyrate (BHB) concentration >3 mmol/L were eligible for inclusion. Patients were randomly assigned to receive either FRI or VRI. INTERVENTIONS: Neutral (regular) insulin was administered IV as an FRI or VRI. For FRI, the rate was maintained at 0.01 IU/kg/h. For VRI, the dose was adjusted according to blood glucose concentration. MEASUREMENTS AND RESULTS: Sixteen cats and 20 dogs were enrolled. Population characteristics, mean insulin infusion rate, time to resolution of ketosis (BHB <0.6 mmol/L), complications, LOH, and STD were evaluated. In cats, overall resolution of ketosis was low (9/16 [56.3%]), limiting comparison of protocols. In dogs, resolution of ketosis was high (19/20 dogs [95.0%]) but the time to resolution in the FRI group was not different than that in the VRI group (P = 0.89), despite a 25% higher average insulin infusion rate in the FRI group (P = 0.04). The incidence of complications was low and did not differ between protocols. In cats, LOH and STD did not differ between protocols. All cats that died (5/16) did so within 78 hours and none had resolution of ketosis. Dogs receiving FRI had a shorter LOH (P = 0.01) but STD did not differ between protocols. Six dogs (30.0%) did not survive to hospital discharge but all had resolution of ketosis. CONCLUSIONS: FRIs can be used in veterinary species but may not hasten resolution of ketosis.
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Search related cases →Original publication on PubMed: https://pubmed.ncbi.nlm.nih.gov/37987148/