CONDITION
Diabetic Ketoacidosis
Diabetic ketoacidosis is a state that can develop when diabetes mellitus has progressed to the point where the body begins breaking down fat for energy in a way that produces acidic compounds called ketones. These ketones accumulate in the blood and make it more acidic, which affects how cells and organs function. It tends to occur in animals with uncontrolled or undiagnosed diabetes, often triggered by another illness, stress, or a period without insulin. Owners most commonly notice their dog or cat becoming profoundly unwell over hours to days—drinking and urinating excessively, refusing food, vomiting, breathing more rapidly or with an unusual smell to the breath, and becoming progressively weaker or less responsive. The animal may have been known to be diabetic, or this may be the first indication that diabetes is present. This page explores the signs that may be observed, what is happening in the body when ketones accumulate, how the condition is investigated through blood and urine tests, and the approaches used to manage it—including insulin, fluid therapy, and correction of the blood's acid–base balance.
Why this matters now
Diabetic ketoacidosis tends to occur in dogs and cats who already have diabetes mellitus, though it may be the first sign that diabetes is present. It can develop at any age where diabetes exists, but is more commonly seen in middle-aged to older animals. Certain triggers—such as concurrent infection, pancreatitis, kidney disease, or periods of stress—often precipitate the shift from controlled or stable diabetes into ketoacidosis.
The progression from diabetes into ketoacidosis typically unfolds over several days, though in some cases it may develop more rapidly. An animal whose diabetes has been stable may deteriorate if insulin is missed, if another illness develops, or if the body's demand for insulin increases beyond what is being provided. The speed and severity of progression can vary considerably between individuals, influenced by the underlying trigger, the duration of insulin deficiency, and the animal's overall metabolic reserve.
Signals & patterns
Early signals
Excessive drinking and urinating
The animal may drink far more than usual and produce large volumes of dilute urine, often needing to go out more frequently or having accidents indoors. This occurs because glucose spills into the urine, pulling water with it and creating a state of dehydration that drives thirst.
Reduced appetite or food refusal
Many animals begin to eat less or stop eating altogether, even if they previously had a normal or increased appetite. The accumulation of ketones and the body's shifting acid balance can contribute to nausea and a loss of interest in food.
Weight loss despite eating
Some animals continue to eat but lose weight because their cells cannot use glucose for energy without sufficient insulin. The body begins to break down fat and muscle stores instead, leading to a gradual loss of body condition.
Vomiting
Episodes of vomiting may occur, sometimes intermittently at first. The nausea is often linked to the rising levels of ketones and changes in blood chemistry, and vomiting can worsen dehydration and electrolyte imbalances.
Later signals
Rapid or laboured breathing
The animal may breathe more quickly or with greater effort, sometimes with an open mouth. This pattern reflects the body's attempt to expel carbon dioxide and compensate for the acidic state of the blood.
Sweet or fruity breath odour
A distinctive sweet, fruity, or acetone-like smell may be noticed on the breath. This odour comes from acetone, one of the ketone bodies being produced and exhaled through the lungs.
Weakness and dullness
The animal may become progressively less responsive, reluctant to move, or unable to stand. This reflects the combined effects of dehydration, electrolyte disturbances, acidosis, and the widespread impact on cellular function.
Click to read about the biological mechanisms
How this is usually investigated
Options & trade-offs
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