Department of Emergency and Critical Care, Willows Referral Service, Solihull, UK.
Section of Emergency and Critical Care, Department of Clinical Science and Services, Royal Veterinary College, London, UK.
J Vet Emerg Crit Care (San Antonio). 2024 Jan-Feb;34(1):23-30. doi: 10.1111/vec.13354. Epub 2023 Nov 21.
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).
Randomized clinical trial (January 2019 to July 2020).
University veterinary teaching hospital and private referral hospital.
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.
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.
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.
FRIs can be used in veterinary species but may not hasten resolution of ketosis.
描述在患有糖尿病酮症酸中毒（DKA）的猫和狗中使用固定速率静脉内胰岛素输注（FRIs），并确定与可变速率静脉内胰岛素输注（VRIs）相比，这是否与酮症更快缓解相关。次要目标是评估并发症发生率、住院时间（LOH）和存活至出院（STD）。
随机临床试验（2019 年 1 月至 2020 年 7 月）。
大学兽医教学医院和私人转诊医院。
有 DKA 和静脉 pH<7.3、血糖浓度>11mmol/L（198mg/dL）和β-羟丁酸（BHB）浓度>3mmol/L 的猫和狗符合入选条件。将患者随机分配接受 FRI 或 VRI。
静脉内给予中性（常规）胰岛素作为 FRI 或 VRI。对于 FRI，维持速率为 0.01IU/kg/h。对于 VRI，根据血糖浓度调整剂量。
纳入了 16 只猫和 20 只狗。评估了人口统计学特征、平均胰岛素输注率、酮症缓解时间（BHB<0.6mmol/L）、并发症、LOH 和 STD。在猫中，酮症的整体缓解率较低（16 只猫中的 9 只[56.3%]），限制了方案的比较。在狗中，酮症的缓解率很高（20 只狗中的 19 只[95.0%]），但 FRI 组的酮症缓解时间与 VRI 组没有差异（P=0.89），尽管 FRI 组的平均胰岛素输注率高 25%（P=0.04）。并发症的发生率较低，两种方案之间没有差异。在猫中，两种方案之间的 LOH 和 STD 没有差异。所有死亡的猫（16 只猫中的 5 只）都在 78 小时内死亡，且没有一只猫的酮症得到缓解。接受 FRI 的狗的 LOH 更短（P=0.01），但两种方案之间的 STD 没有差异。6 只狗（30.0%）没有存活到出院，但所有狗的酮症都得到缓解。
FRIs 可用于兽医物种，但可能不会加速酮症缓解。
