Hyperosmolar hyperglycemia in 66 diabetic dogs studied 1993-2008

Abstract

OBJECTIVES: To clinically characterize a large group of dogs with the hyperosmolar hyperglycemic state (HHS) and to determine whether 2 HHS subgroups, dogs with hyperosmolar ketonuric (HK) diabetes mellitus (DM) and dogs with hyperosmolar nonketonuric (HNK) DM were clinically different from one another. DESIGN: Retrospective study. Records of 1,250 diabetic dogs that were examined between January 1993 and July 2008 were reviewed in order to identify dogs with HHS. Inclusion required a calculated serum osmolality ≥325 mOsm/kg, with or without ketonuria. SETTING: University teaching hospital. ANIMALS: Sixty-six dogs with HHS including 34 dogs with HK, 25 dogs with HNK, and 7 dogs with unclassified HHS. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: HHS was diagnosed in 5% of dogs with DM. HK and HNK dogs were similar to one another in regard to most historical, physical examination, and clinicopathologic variables as well as outcome. Sixty-two percent of dogs with HHS survived to discharge from the hospital. Poor outcome of HHS dogs was associated with abnormal mental status (P = 0.03) and a low venous pH (P = 0.045). Dogs with HK were significantly more likely to have acute pancreatitis (P = 0.046), higher body temperature (P = 0.006), higher WBC count (P = 0.01), and a shorter duration of clinical signs (P = 0.02) compared to dogs with HNK. Dogs with HNK had significantly higher BUN and creatinine concentrations (P = 0.0002 and P = 0.008, respectively) and higher calculated osmolality (P = 0.001) compared to dogs with HK. CONCLUSIONS: HHS is a rare condition in which poor outcome is associated with abnormal mental status and low venous pH. Among dogs with HHS, the subgroup of dogs with HK has significantly more acute pancreatitis, shorter duration of clinical signs, and higher body temperature and WBC count compared to dogs with HNK, whereas dogs with HNK have more azotemia and higher calculated osmolality compared to dogs with HK.