ketonuria

Re: ketonuria

Anonymous — Thu, 23 Oct 2014 20:58:32 GMT

Hi Gareth, once I had to drop in a urine sample myself - I had produced it after a night with a migraine where I had not drunken a lot of water all day. I had loads of Ketones in it and the consultant said it was because I was dehydrated. Maybe that is all that is to it???

Re: ketonuria

Gareth C. — Thu, 23 Oct 2014 20:17:45 GMT

Thanks for the comments. Bg up to 20this am still very bright. We are treating as a dm but will keep open mind as to other factors.

I also have diabetic old cat who is superstable and been on insulin for a few years . Interestingly his weight curve showed a big drop about 2 yrs before he got ill and diagnosed, which then shot back up to normal when on TX. I often wonder how long animals have been diabetic before presentation? I think in the cat possibly years, and I guess could explain the ketones in a very well "slightly diabetic " westie who may have been metaobolising some fat for months.

Re: ketonuria

Amy Lam — Thu, 23 Oct 2014 16:46:59 GMT

Hi Gareth

I think your case raises questions in our assessment of glucose tolerance. Your dog does have hyperglycaemia. The question is is that pathological or physiological. If it has glucosuria / ketonuria- you would assume the former.

Your Westie has hyperglycaemia, but at 13mmol/L - is that over the renal threshold? Most studies say 15mmol/L (in cats, possibly lower in dogs). The cause of hyperglycaemia is due to in-sufficient insulin activity. This could be due to lack of insulin, or insulin antagonism.

Ketonuria is caused by alternative pathways to glycolysis - so fat / muscle catabolism. This can be seen in anorexia, or due to insulin antagnosim.

If your dog didn't have mild hyperglycaemia, I would also consider proximal renal tubular acidosis as a differential. This has been seen in Wesite's with Copper storage hepatopathies.

So my suggestion would be to

1) record the blood glucose another couple of times i.e document consistent hyperglycaemia.

2) do a fructosamine - which assesses longer-term glycaemic control than the spot glucose

3) Keep the Zebra's (Cushings / Acquired Fanconi) at the back of your mind

Hope your dog does OK - in my opinion - in these cases fluids are definitely the priority!

Amy

Re: ketonuria

Amy Lam — Thu, 23 Oct 2014 16:46:57 GMT

Hi Gareth

Ketonuria is caused by alternative pathways to glycolysis - so fat / muscle catabolism. This can be seen in anorexia, or due to insulin antagnosim.

If your dog didn't have mild hyperglycaemia, I would also consider proximal renal tubular acidosis as a differential. This has been seen in Wesite's with Copper storage hepatopathies.

So my suggestion would be to

1) record the blood glucose another couple of times i.e document consistent hyperglycaemia.

2) do a fructosamine - which assesses longer-term glycaemic control than the spot glucose

3) Keep the Zebra's (Cushings / Acquired Fanconi) at the back of your mind

Hope your dog does OK - in my opinion - in these cases fluids are definitely the priority!

Amy

Re: ketonuria

Martin Atkinson — Thu, 23 Oct 2014 09:56:13 GMT

I wouldn't expect a dog to be keto-acedotic with a BG of 13mmol/l of course it depends on when you took the sample i.e. if it was a post or pre-prandial. I assume you've done a full biochemistry work-up and urine cortisol/creatinine ratio may be useful just in case there is another issue. Fructosamine is helpful but don't rely on it. Not wishing to treat granny to sick eggs, if it truly is DM then start on minimum dose insulin and perform insulin response curves, don't rely on spot glucose or fructosamine to determine if stabilised.

Re: ketonuria

Braden Collins — Thu, 23 Oct 2014 09:17:26 GMT

Hi Gareth.

Sounds like a pretty straight forward DM, though Bg is not super high. Probably worth doing a fructosamine just for peace of mind but in a dog DM jumps out as only likely cause. Depending on age, etc consider checking for Cushings as well as in older Westies I find the DM will be complicated by Cushings.

Treat the DM and the ketones will take care of themselves. I would say not too much to worry about here. If the dog is well in itself, drinking and eating I won't normally hospitalise on fluids, but that being said I don't think it is necessarily wrong to.