title: Use of intravenous insulin aspart for treatment of naturally occurring diabetic ketoacidosis in dogs.
abstract: OBJECTIVE
  To characterize the utility and safety of IV insulin aspart in the treatment of diabetes ketoacidosis (DKA) in dogs and to determine the times to resolution of hyperglycemia, ketonemia, and acidemia in dogs treated with IV insulin aspart.
  
  
  METHODS
  Prospective noncontrolled single arm study of dogs with DKA between February 2010 and March 2011.
  
  
  METHODS
  University teaching hospital.
  
  
  METHODS
  Six dogs with spontaneous DKA and blood glucose (BG) concentration >13.8 mmol/L (250 mg/dL), pH between 7.0 and 7.35, and blood beta-hydroxybutyrate >2.0 mmol/L were treated with an IV continuous rate infusion (CRI) of aspart insulin. The time to biochemical resolution of DKA was defined as the time interval from when the IV CRI of aspart insulin began until marked hyperglycemia (BG concentration >13.8 mmol/L [250 mg/dL]), acidemia (venous pH <7.35), and ketonemia (beta-hydroxybutyrate concentration >2.0 mmol/L) resolved. Aspart insulin was administered as an IV CRI at an initial dose of 0.09 U/kg/h. The dose was adjusted according to a previously published protocol.
  
  
  RESULTS
  The median time to biochemical resolution of DKA in dogs treated with insulin aspart was 28 hours (range, 20-116 h). Mean BG concentration decreased significantly from the time IV fluid resuscitation began (32.0 mmol/L [576 mg/dL]; range, 14.9-38.9 mmol/L [268-700 mg/dL]) until 6 hours later when IV aspart insulin CRI began (20.1 mmol/L [363 mg/dL]; range, 9.4-26.1 mmol/L [169-470 mg/dL], P = 0.03). No adverse effects were observed in association with IV insulin aspart administration. Median cost of hospitalization was US$3,477 (range, US$1,483-10,469). Median total units per kilogram of administered IV insulin aspart was 2.97 U/kg (range, 2.04-10.52 U/kg).
  
  
  CONCLUSIONS
  Intravenous CRI of insulin aspart is a safe and effective treatment for DKA in dogs. IV fluid resuscitation is recommended prior to insulin administration.
authors.affiliation: Matthew J. Ryan Veterinary Hospital, University of Pennsylvania, Philadelphia, PA, 19104.
authors.forename: Eric S
authors.initials: ES
authors.lastname: Walsh
authors.affiliation: Matthew J. Ryan Veterinary Hospital, University of Pennsylvania, Philadelphia, PA, 19104.
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Drobatz
authors.affiliation: Matthew J. Ryan Veterinary Hospital, University of Pennsylvania, Philadelphia, PA, 19104.
authors.forename: Rebecka S
authors.initials: RS
authors.lastname: Hess
mesh_terms: D000818:Animals; D003422:Critical Care; D016883:Diabetic Ketoacidosis / Q000188:drug therapy / Q000662:veterinary*; D004283:Dog Diseases / Q000188:drug therapy*; D004285:Dogs; D006760:Hospitalization; D006943:Hyperglycemia; D007262:Infusions, Intravenous; D007279:Injections, Subcutaneous; D061267:Insulin Aspart / Q000627:therapeutic use*; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D061267:Insulin Aspart
keywords: DKA; canine; ketosis; therapy