EMERGENCY THERAPY OF DIABETIC CRISES - INSULIN OVERDOSE, DIABETIC-KETOACIDOSIS, AND HYPEROSMOLAR COMA

Diabetes mellitus (DM) is probably the most common endocrine disorder observed in the emergency setting.(41) Three types of diabetic emergen cies occur, These are (1) insulin overdose; (2) diabetic ketoacidosis; and (3) nonketotic hyperosmolar coma. Historic findings may be simila r in all three instances, and may include polyuria, polydypsia, weight loss, anorexia, weakness, ataxia, severe depression, stupor, coma, Or seizures.(10, 26, 27, 41) DM most commonly occurs in middle-aged fema le dogs and older male cats.(11, 38) The initial approach to an animal with suspected diabetic crisis is aimed toward differentiating betwee n the three types of diabetic emergencies and determining the severity of the metabolic derangements. An immediate data base can be obtained when the initial intravenous (IV) catheter is placed and should inclu de samples for hematocrit, total solids, blood urea nitrogen, blood gl ucose, serum electrolytes, and urinalysis. Glucose reagent strips (Glu cofilm, Miles, Inc, Elkhart, IN; Chemstrip bG, Boehringer Mannheim Dia gnostics, Indianapolis, IN) require only a drop of blood and give reas onably accurate values. Accuracy can be improved by using a reflectanc e colorimeter made specifically to be used with certain brands of reag ent strips (e.g., Glucofilm is used with Glucometer 3, Miles Inc,). Ev aluation of the laboratory work will show whether the animal is hypogl ycemic or hyperglycemic, and whether or not ketones and glucose are pr esent in the urine, and whether the animal is dehydrated, anemic, azot emic, or has a serious electrolyte imbalance. Other tests that can be performed rapidly in an emergency setting include serum osmolality and venous or arterial blood gases. Within a few minutes after the animal presents to the hospital, the clinician should be able to determine w hich type of diabetic crisis is occurring, how severely affected the a nimal is, and initiate an appropriate therapeutic plan.