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DISEASE · DOGS AND CATS

Diabetic ketoacidosis in dogs and cats: the emergency blood work

Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes. Without enough insulin, the body burns fat and produces ketones, which make the blood acidic. It is often the way diabetes is first discovered, and it usually comes with another illness such as pancreatitis.

Written by the AI DiagAnimals editorial teamReviewed by the AI DiagAnimals TeamUpdated Our editorial policy

The essentials

DKA combines three findings: high blood glucose, ketones, and acidic blood (metabolic acidosis). A urine strip detects mainly acetoacetate, not the main ketone (beta-hydroxybutyrate, BHB), so it can be negative in DKA; a blood BHB test is more reliable. Sodium, potassium and phosphate are often abnormal and can drop further once insulin starts, so they are checked often. Most dogs and cats with DKA have another disease, especially pancreatitis. With intensive care, about 70% of dogs and cats survive to go home.

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What DKA is

DKA is defined by the triad of high glucose, metabolic acidosis and ketones [1]. In 127 dogs with DKA, 65% had not yet been diagnosed with diabetes, and 69% had at least one other disease: acute pancreatitis (41%), urinary infection and Cushing’s disease were the most common [2]. In 42 cats, concurrent diseases were found in 39, including fatty liver, cholangiohepatitis, pancreatitis, kidney disease, urinary infection and cancer [3].

Ketones: why the urine strip can miss DKA

Urine strips detect mainly acetoacetate and, to a lesser extent, acetone; they do not detect beta-hydroxybutyrate (BHB) [4], which becomes the dominant ketone in DKA [1]. In one study of dogs with DKA, 20% had a negative urine ketone test at diagnosis [1]. Blood BHB, measured in the laboratory or with a hand-held meter, is more reliable.

An annotated line from a lab report · Illustrative example
AbbreviationResultUnitLaboratory intervalFlag
BHB Beta-hydroxybutyrate6.2mmol/L0–0.1H
  1. Abbreviation BHB, β-OHB or 3-HB: the main ketone in the blood.
  2. Result 6.2 mmol/L in this illustrative line from a cat: in the range seen in DKA.
  3. Unit mmol/L.
  4. Laboratory interval Healthy cats had values of 0–0.1 mmol/L; cats with DKA had 3.8–12.2 mmol/L [5].
  5. Flag H: above the interval. Read with the glucose and the blood gas: acidosis confirms ketoacidosis rather than simple ketosis [1].

In dogs, a capillary BHB above 3.8 mmol/L had a sensitivity of 70% and a specificity of 92% for DKA [1]; in cats, a meter value below 2.55 mmol/L made ketoacidosis unlikely [6].

What the rest of the blood work shows

  • Glucose: high, often far above the interval [1, 3]. See diabetes in dogs and diabetes in cats.
  • Sodium and chloride: often low; in 10 dogs, all had low sodium [1, 3].
  • Potassium and phosphate: often low in cats at diagnosis, and they fall further once insulin moves them into the cells [3, 7]. A phosphate below 1.0 mg/dL in dogs or 1.5 mg/dL in cats can destroy red cells [7].
  • Kidney values, liver enzymes and fats: cats often have raised urea and creatinine and raised ALT [3]; lack of insulin raises triglycerides and cholesterol, making the serum cloudy [8].

Because these values change quickly, they are rechecked several times a day during treatment. See potassium in dogs and cats.

Outlook

In 127 dogs, 70% of treated dogs survived to discharge, after a median stay of 6 days; dogs with Cushing’s disease were less likely to go home [2]. In 42 cats, 11 died or were euthanised, and DKA recurred in 13 of the survivors [3]. About 1 dog in 5 that survives has another episode later [9].

Related articles

En français : l’acidocétose diabétique.

Questions to ask your veterinarian

  1. Is this ketosis or ketoacidosis: what do the blood ketones and blood gas show?
  2. Are the sodium, potassium and phosphate low?
  3. Is there pancreatitis, a urinary infection or another disease behind it?
  4. How often will the electrolytes be rechecked during treatment?
  5. How do we monitor ketones at home afterwards?
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Frequently asked questions

What are the three signs of DKA?

On blood tests: high glucose, ketones and acidic blood. At home, a diabetic pet that vomits, stops eating and becomes weak needs urgent care [1].

My diabetic dog is vomiting. Should I be concerned?

Yes. Vomiting and not eating can be the first signs of DKA or pancreatitis. Call your vet before giving insulin [2].

Can the urine strip be negative in DKA?

Yes. Strips do not detect BHB, the main ketone in DKA; 20% of dogs with DKA had a negative urine test in one study [1, 4].

How long can cats live with DKA?

Most cats that survive the crisis go home; DKA can recur, so the diabetes and the concurrent diseases need close follow-up [3].

What can be mistaken for DKA?

Simple ketosis without acidosis, or other causes of acidosis and vomiting. A blood gas and blood BHB make the difference [1].

Sources

  1. Bresciani F et al. Accuracy of capillary blood 3-β-hydroxybutyrate determination for the detection and treatment of canine diabetic ketoacidosis. J Vet Sci. 2014;15(2):309-316. doi.org/10.4142/jvs.2014.15.2.309
  2. Hume DZ et al. Outcome of dogs with diabetic ketoacidosis: 127 dogs (1993-2003). J Vet Intern Med. 2006;20(3):547-555. pubmed.ncbi.nlm.nih.gov/16734088
  3. Bruskiewicz KA et al. Diabetic ketosis and ketoacidosis in cats: 42 cases (1980-1995). J Am Vet Med Assoc. 1997;211(2):188-192. pubmed.ncbi.nlm.nih.gov/9227749
  4. eClinPath, Cornell University College of Veterinary Medicine. Urinalysis: chemical constituents. eclinpath.com/urinalysis/chemical-constituents
  5. Weingart C et al. Measurement of β-hydroxybutyrate in cats with nonketotic diabetes mellitus, diabetic ketosis, and diabetic ketoacidosis. J Vet Diagn Invest. 2012;24(2):295-300. doi.org/10.1177/1040638711428332
  6. Zeugswetter FK, Rebuzzi L. Point-of-care β-hydroxybutyrate measurement for the diagnosis of feline diabetic ketoacidaemia. J Small Anim Pract. 2012;53(6):328-331. doi.org/10.1111/j.1748-5827.2012.01204.x
  7. eClinPath, Cornell University College of Veterinary Medicine. Phosphate. eclinpath.com/chemistry/minerals/phosphate
  8. eClinPath, Cornell University College of Veterinary Medicine. Cholesterol. eclinpath.com/chemistry/energy-metabolism/cholesterol
  9. Edwards SM, Hess RS. The Acute Patient Physiologic and Laboratory Evaluation Score and other prognostic factors in dogs with diabetic ketoacidosis. J Vet Intern Med. 2025;39(2):e70044. doi.org/10.1111/jvim.70044

Laboratory methods and reference intervals vary. This article explains; it does not diagnose. For a decision about your pet, use the original report and talk to your veterinarian. Our editorial policy.

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