The highly respected Professor Mike Herrtage from Cambridge University has legendary status in the veterinary world and can always be relied upon to deliver information packed, relevant and practical veterinary webinars for ‘The Webinar Vet’. It therefore came as little surprise that last week’s webinar covering ketoacidosis in dogs was no exception.

Reminding us about the pathogenesis of ketoacidosis was an important element of Professor Herrtage’s discussion and although this is often an area I need to search long and hard for way back in the depths of my memory, an understanding of how ketoacidosis develops is essential for diagnosing and managing  this condition. For example the ketone bodies produced in a ketoacidotic dog are acetone, acetoacetic acid and beta hydroxybutyrate. Most of us will use human dipsticks for measuring ketones and these sticks only measure acetone and acetoacetic acid, omitting beta hydroxybutyrate. There will be some circumstances where beta hydroxybutyrate is the main ketone produced in the ketoacidotic dog and the level of ketosis could be seriously underestimated in these cases.

However, in most cases Professor Herrtage explained ketoacidosis is relatively simple to diagnose. The presence of hyperglycaemia and ketonuria should be adequate to make a diagnosis. However when a diabetic comes in collapsed, it can be challenging to ascertain if a patient is suffering from a hypoglycaemic crisis or ketoacidosis, regardless of how simple the textbooks make it sound to differentiate between the two conditions.  Professor Herrtage advised that most patients suffering from hypoglycaemia will probably have a crisis around 6-8 hours post their insulin dose despite having had previous good health. Dogs suffering from ketoacidosis are more likely to have a gradual decline in their health and on presentation will have ketones in their urine compared to hypoglycaemic dogs which will be glucose negative.

However, as stated previously, it is not always that easy to make a diagnosis in the short time you have to deal with a collapsed or comatosed dog, and Professor Herrtage advised that if in any doubt at all, it would be better to assume the dog is hypoglycaemic and treat with glucose to prevent any potential life threatening brain damage. If hypoglycaemic there will be a dramatic response after treating with iv glucose but if the patient is suffering from ketoacidosis, treating with glucose will certainly not help but equally it should not be significantly detrimental.

Needless to say, Professor Herrtage gave extensive advice on how to manage cases of ketoacidosis once diagnosed. Aggressive fluid therapy is always necessary to treat the life threatening hypovolaemia alongside a constant rate infusion of insulin. Professor Herrtage provided simple calculations for setting up these infusions, and if, like me, you have always found working out infusion rates somewhat stressful, Professor Herrtage’s explanation could not be any simpler. For all of you out there without infusion pumps, doses were also given for IV and IM boluses of insulin.

This veterinary webinar is the type of CPD which gives methodical and practical advice on how to deal with ketoacidotic dogs taking away any fear of handling such complex medical cases. It is a webinar that should be at the tip of your fingers in practice so if we do have the misfortune of being presented with a ketoacidotic dog, they will, without doubt be in good hands.