Comparison of insulin infusion protocols for management of canine and feline diabetic ketoacidosis

IF 1.1 3区农林科学 Q3 VETERINARY SCIENCES

Journal of veterinary emergency and critical care Pub Date : 2023-11-21 DOI:10.1111/vec.13354

Poppy Gant BVSc, MVetMed, DACVECC, DECVECC, Dominic Barfield BSc, BVSc, MVetMed, DACVECC, DECVECC, Jessica Florey BVM&S, MVetMed, DACVIM, DECVIM

{"title":"Comparison of insulin infusion protocols for management of canine and feline diabetic ketoacidosis","authors":"Poppy Gant BVSc, MVetMed, DACVECC, DECVECC, Dominic Barfield BSc, BVSc, MVetMed, DACVECC, DECVECC, Jessica Florey BVM&S, MVetMed, DACVIM, DECVIM","doi":"10.1111/vec.13354","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Objective</h3>\n \n <p>Describe the use of fixed-rate intravenous insulin infusions (FRIs) in cats and dogs with diabetic ketoacidosis (DKA) and determine if this is associated with faster resolution of ketosis compared to variable-rate intravenous insulin infusions (VRIs). Secondary objectives were to evaluate complication rates, length of hospitalization (LOH), and survival to discharge (STD).</p>\n </section>\n \n <section>\n \n <h3> Design</h3>\n \n <p>Randomized clinical trial (January 2019 to July 2020).</p>\n </section>\n \n <section>\n \n <h3> Setting</h3>\n \n <p>University veterinary teaching hospital and private referral hospital.</p>\n </section>\n \n <section>\n \n <h3> Animals</h3>\n \n <p>Dogs and cats with DKA and venous pH <7.3, blood glucose concentration >11 mmol/L (198 mg/dL), and β-hydroxybutyrate (BHB) concentration >3 mmol/L were eligible for inclusion. Patients were randomly assigned to receive either FRI or VRI.</p>\n </section>\n \n <section>\n \n <h3> Interventions</h3>\n \n <p>Neutral (regular) insulin was administered IV as an FRI or VRI. For FRI, the rate was maintained at 0.01 IU/kg/h. For VRI, the dose was adjusted according to blood glucose concentration.</p>\n </section>\n \n <section>\n \n <h3> Measurements and Results</h3>\n \n <p>Sixteen cats and 20 dogs were enrolled. Population characteristics, mean insulin infusion rate, time to resolution of ketosis (BHB <0.6 mmol/L), complications, LOH, and STD were evaluated. In cats, overall resolution of ketosis was low (9/16 [56.3%]), limiting comparison of protocols. In dogs, resolution of ketosis was high (19/20 dogs [95.0%]) but the time to resolution in the FRI group was not different than that in the VRI group (<i>P</i> = 0.89), despite a 25% higher average insulin infusion rate in the FRI group (<i>P</i> = 0.04). The incidence of complications was low and did not differ between protocols. In cats, LOH and STD did not differ between protocols. All cats that died (5/16) did so within 78 hours and none had resolution of ketosis. Dogs receiving FRI had a shorter LOH (<i>P</i> = 0.01) but STD did not differ between protocols. Six dogs (30.0%) did not survive to hospital discharge but all had resolution of ketosis.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>FRIs can be used in veterinary species but may not hasten resolution of ketosis.</p>\n </section>\n </div>","PeriodicalId":17603,"journal":{"name":"Journal of veterinary emergency and critical care","volume":"34 1","pages":"23-30"},"PeriodicalIF":1.1000,"publicationDate":"2023-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/vec.13354","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of veterinary emergency and critical care","FirstCategoryId":"97","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/vec.13354","RegionNum":3,"RegionCategory":"农林科学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"VETERINARY SCIENCES","Score":null,"Total":0}

引用次数: 0

Abstract

Objective

Describe the use of fixed-rate intravenous insulin infusions (FRIs) in cats and dogs with diabetic ketoacidosis (DKA) and determine if this is associated with faster resolution of ketosis compared to variable-rate intravenous insulin infusions (VRIs). Secondary objectives were to evaluate complication rates, length of hospitalization (LOH), and survival to discharge (STD).

Design

Randomized clinical trial (January 2019 to July 2020).

Setting

University veterinary teaching hospital and private referral hospital.

Animals

Dogs and cats with DKA and venous pH <7.3, blood glucose concentration >11 mmol/L (198 mg/dL), and β-hydroxybutyrate (BHB) concentration >3 mmol/L were eligible for inclusion. Patients were randomly assigned to receive either FRI or VRI.

Interventions

Neutral (regular) insulin was administered IV as an FRI or VRI. For FRI, the rate was maintained at 0.01 IU/kg/h. For VRI, the dose was adjusted according to blood glucose concentration.

Measurements and Results

Sixteen cats and 20 dogs were enrolled. Population characteristics, mean insulin infusion rate, time to resolution of ketosis (BHB <0.6 mmol/L), complications, LOH, and STD were evaluated. In cats, overall resolution of ketosis was low (9/16 [56.3%]), limiting comparison of protocols. In dogs, resolution of ketosis was high (19/20 dogs [95.0%]) but the time to resolution in the FRI group was not different than that in the VRI group (P = 0.89), despite a 25% higher average insulin infusion rate in the FRI group (P = 0.04). The incidence of complications was low and did not differ between protocols. In cats, LOH and STD did not differ between protocols. All cats that died (5/16) did so within 78 hours and none had resolution of ketosis. Dogs receiving FRI had a shorter LOH (P = 0.01) but STD did not differ between protocols. Six dogs (30.0%) did not survive to hospital discharge but all had resolution of ketosis.

Conclusions

FRIs can be used in veterinary species but may not hasten resolution of ketosis.

Abstract Image

查看原文本刊更多论文

胰岛素输注治疗犬和猫糖尿病酮症酸中毒的比较。

目的:描述固定速率静脉注射胰岛素(FRIs)在患有糖尿病酮症酸中毒(DKA)的猫和狗中的应用，并确定与可变速率静脉注射胰岛素(VRIs)相比，这是否与更快地解决酮症有关。次要目的是评估并发症发生率、住院时间(LOH)和出院生存率(STD)。设计:随机临床试验(2019年1月至2020年7月)。单位:大学兽医教学医院和私立转诊医院。动物:DKA和静脉pH为11 mmol/L (198 mg/dL)， β-羟基丁酸(BHB)浓度为bbb30 mmol/L的狗和猫符合纳入条件。患者被随机分配接受FRI或VRI。干预措施:中性(常规)胰岛素作为FRI或VRI静脉注射。FRI的添加速率维持在0.01 IU/kg/h。对于VRI，剂量根据血糖浓度调整。测量和结果:16只猫和20只狗被纳入研究。结论:FRIs可用于兽类，但可能不能加速酮症的消退。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Journal of veterinary emergency and critical care 农林科学-兽医学

CiteScore

2.50

自引率

15.40%

发文量

121

审稿时长

18-36 weeks

期刊介绍： The Journal of Veterinary Emergency and Critical Care’s primary aim is to advance the international clinical standard of care for emergency/critical care patients of all species. The journal’s content is relevant to specialist and non-specialist veterinarians practicing emergency/critical care medicine. The journal achieves it aims by publishing descriptions of unique presentation or management; retrospective and prospective evaluations of prognosis, novel diagnosis, or therapy; translational basic science studies with clinical relevance; in depth reviews of pertinent topics; topical news and letters; and regular themed issues. The journal is the official publication of the Veterinary Emergency and Critical Care Society, the American College of Veterinary Emergency and Critical Care, the European Veterinary Emergency and Critical Care Society, and the European College of Veterinary Emergency and Critical Care. It is a bimonthly publication with international impact and adheres to currently accepted ethical standards.