Electrolytes – VETEMCRIT

Management of Hyperosmolar Hyperglycemic State (HHS) in Dogs and Cats: A Clinical Guideline for Small Animal Practitioners

Introduction

This guideline created by the VETEMCRIT Academy is based on the most current veterinary and human medical literature, encompassing both adult and pediatric research. It was designed as a practical clinical tool for small animal veterinary practitioners.

What is HHS?

HHS (Hyperosmolar Hyperglycemic State) is a form of diabetic crisis characterized by severe hyperglycemia (>600 mg/dL or >33 mmol/L), minimal or absent urine/plasma ketones, and serum osmolality greater than 325 mOsm/kg in dogs or 350 mOsm/kg in cats (Koenig et al. 2022).

Diabetic Ketoacidosis (DKA) and HHS are both forms of diabetic crises. They can be viewed as different manifestations along the same spectrum, as evidenced by the fact that some veterinary and human patients present with a combination of HHS and DKA.

However, there are distinct features of HHS that differentiate it from DKA. Veterinarians must be aware of these differences, as they may impact clinical management.

Unveiling the Mysteries of Ketone Detection in Diabetic Ketoacidosis

Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes mellitus that requires prompt diagnosis and treatment. One of the hallmarks of DKA is the presence of ketone bodies in the blood and urine. In this blog post, we’ll dive into the fascinating world of ketone detection and explore the various methods used to identify ketonemia and ketonuria in dogs and cats.

Deep dive into insulin infusion protocols for management of diabetic ketoacidosis in dogs and cats

Diabetic ketoacidosis (DKA) is a relatively common complication of diabetes mellitus in dogs and cats. In the face of insulin deficiency or resistance, the liver produces ketones to provide an alternative energy source from glucose. However, excessive ketone production can lead to high anion gap metabolic acidosis and other negative effects. Besides restoration of intravascular and interstitial fluid deficits as well as electrolyte derangements such as hypokalemia, insulin administration is necessary to stop production of ketones, reduce lipolysis and enhance cellular uptake of glucose.

Several insulin protocols have been described in veterinary medicine to treat DKA patients during the first 24-72 hours of hospitalization until the patient becomes stable and regains appetite. One of the most commonly utilized protocols in clinical practice is an intravenous variable-rate insulin infusion protocol when a short-acting insulin is infused IV and the rate is altered based on blood glucose concentration (Figure 1).

Hyperkalemia Associated with General Anesthesia in Dogs and Cats

Hyperkalemia has been reported as a complication of general anesthesia in systemically healthy animals with normal renal function. Several case reports and case series are summarized in Table 1. Upon reviewing the literature, several distinct patterns and interesting observations are worth discussing. Some of these observations may be relevant to veterinary practitioners and technicians dealing with anesthetized animals or managing their post-anesthetic recovery.

Intravenous phosphate supplementation in dogs and cats

In animals and humans, phosphorus plays a crucial role in the synthesis of several compounds that are vital for maintaining cellular membrane integrity, energy stores, metabolic processes, and biochemical messenger systems. These compounds include ATP, guanosine triphosphate, cyclic adenosine monophosphate, and phosphocreatine (Yanagawa et al. 1994; DiBartola et al. 2012). Phosphate is a molecular anion that contains phosphorus. Approximately 80-85% of phosphate resides in the bone and teeth as inorganic hydroxyapatite, 14-15% in soft tissues, and less than 1% in the extracellular space (Yanagawa et al. 1994; DiBartola et al. 2012). The body and plasma contain both organic and inorganic phosphates, though blood chemistry analyzers measure only inorganic phosphates.