Cetoacidose diabética em animais de companhia: um estudo retrospetivo de 15 casos clínicos
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2015-09-08
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A cetoacidose diabética (CAD) é uma complicação grave e, potencialmente fatal, da diabetes melitos, caracterizada pela tríade bioquímica de hiperglicemia, hipercetonémia e acidose metabólica. Este distúrbio metabólico resulta de deficiências absolutas ou relativas de insulina e do aumento simultâneo de hormonas diabetogénicas (especialmente glucagon), causado, muitas vezes, pela presença de doenças concorrentes.
Este trabalho teve como objetivo caracterizar uma amostra de 15 animais com cetoacidose diabética, 14 cães e 1 gato, que se apresentaram ao Hospital Clínic Veterinari da Universitat Autònoma de Barcelona (HVC-UAB) e no Hospital Veterinário Central (HVC) entre 2006 e 2013 e, compara-la à literatura recolhida. As variáveis em estudo foram divididas em epidemiológicas (raça, sexo, estado reprodutivo, idade ao diagnóstico e diagnóstico prévio da diabetes), clínicas (tipo de consulta, principais motivos da consulta, sinais clínicos, número de dias de internamento, tratamento efetuado e recuperação do estado de crise cetoacidótica) e laboratoriais (alterações hematológicas, bioquímicas, eletrolíticas, gasométricas e da tira de urina).
Após a análise dos resultados, na amostra da espécie canina, verificou-se que a presença de CAD foi predominante em cães de raça indeterminada e em fêmeas inteiras. O felino em estudo era um macho castrado de raça pura. O diagnóstico da CAD foi realizado em animais de idade a adulta a geriátrica. Os principais motivos de consulta e sinais clínicos envolveram a presença de vómito, apatia, Pd/Pu. As principais alterações laboratoriais incluíram hiperglicemia, aumento dos níveis da fosfatase alcalina, ureia e colesterol, hipocalemia, hipocloremia, glicosúria, cetonúria e diminuição do pH, PCO2 e HCO3-. Com a exceção de um animal, todos foram internados e sujeitos a terapia com fluidos e insulina. No tratamento destaca-se, ainda, a utilização de insulina de ação rápida e a não suplementação com bicarbonato.
Conclui-se que, apesar de algumas divergências encontradas, a sintomatologia, as principais alterações laboratoriais e a abordagem terapêutica observados nos animais em estudo refletem o descrito na literatura.
Diabetic ketoacidosis (DKA) is a serious and potentially fatal complication of diabetes mellitus that is characterized by the biochemical triad of hyperglycemia, hyperketonemia, and metabolic acidosis. This metabolic disorder results from relative or absolute insulin deficiencies and the simultaneous rise of counterregulatory hormones, especially glucagon, which is often caused by the presence of concurrent disorders. The aim of this work is to caracterize 15 animals with diabetic ketoacidosis, 14 dogs and 1 cat, who have presented consultation on Hospital Clínic Veterinari da Universitat Autònoma de Barcelona (HVC-UAB) e no Hospital Veterinário Central (HVC), between 2006 and 2013 and, compares them with the collected literature. The variables will be addresses in epidemiological (race, sex, reproductive status, age at diagnosis and previous diagnosis of diabetes), clinical (type and the main reasons for consultation, clinical signs, number of days of hospitalization, treatment and the recovery of the ketoacidosis crisis) and laboratorial (hematological, biochemical, electrolyte, blood gases and urine strip). After analyzing the results, in the canine specie, it was found that the presence of DKA is more likely in undetermined breeds and no castrated females. The cat included in this study was a castrated male of pure breed. The diagnosis of DKA was mostly seen in adult to geriatric-aged animals. The main reasons for consulting and clinical signs involved the presence of vomiting, apathy and Pd/Pu. The main laboratorial abnormalities included hyperglycemia, increased levels of alkaline phosphatase, urea and cholesterol, hypokalemia, hypochloremia, glycosuria, ketonuria and decreased levels of pH, PCO2 and HCO3-. With the exception of one animal, all subjects were admitted to fluid and insulin therapy. The treatment stands out the use of rapid-acting insulin and no supplementation with bicarbonate. We concluded that, despite some divergences, the symptoms, the main laboratorial findings and the therapeutic approach are in accordance with literature.
Diabetic ketoacidosis (DKA) is a serious and potentially fatal complication of diabetes mellitus that is characterized by the biochemical triad of hyperglycemia, hyperketonemia, and metabolic acidosis. This metabolic disorder results from relative or absolute insulin deficiencies and the simultaneous rise of counterregulatory hormones, especially glucagon, which is often caused by the presence of concurrent disorders. The aim of this work is to caracterize 15 animals with diabetic ketoacidosis, 14 dogs and 1 cat, who have presented consultation on Hospital Clínic Veterinari da Universitat Autònoma de Barcelona (HVC-UAB) e no Hospital Veterinário Central (HVC), between 2006 and 2013 and, compares them with the collected literature. The variables will be addresses in epidemiological (race, sex, reproductive status, age at diagnosis and previous diagnosis of diabetes), clinical (type and the main reasons for consultation, clinical signs, number of days of hospitalization, treatment and the recovery of the ketoacidosis crisis) and laboratorial (hematological, biochemical, electrolyte, blood gases and urine strip). After analyzing the results, in the canine specie, it was found that the presence of DKA is more likely in undetermined breeds and no castrated females. The cat included in this study was a castrated male of pure breed. The diagnosis of DKA was mostly seen in adult to geriatric-aged animals. The main reasons for consulting and clinical signs involved the presence of vomiting, apathy and Pd/Pu. The main laboratorial abnormalities included hyperglycemia, increased levels of alkaline phosphatase, urea and cholesterol, hypokalemia, hypochloremia, glycosuria, ketonuria and decreased levels of pH, PCO2 and HCO3-. With the exception of one animal, all subjects were admitted to fluid and insulin therapy. The treatment stands out the use of rapid-acting insulin and no supplementation with bicarbonate. We concluded that, despite some divergences, the symptoms, the main laboratorial findings and the therapeutic approach are in accordance with literature.
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Dissertação de Mestrado Integrado em Medicina Veterinária
Palavras-chave
Animais de estimação , Cetoacidose diabética , Insulina , Distúrbio metabólico , Hiperglicemia , Corpos cetónicos , Cetose