Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, Chungbuk, Republic of Korea.
College of Veterinary Medicine, Kyungpook National University, Daegu, Republic of Korea.
Vet Med Sci. 2024 Sep;10(5):e1552. doi: 10.1002/vms3.1552.
A 6-year-old spayed female domestic short-hair cat was presented for primary complaints of anorexia and lethargy. The cat was being treated with cyclosporine (25 mg/cat, PO q24h) and prednisolone (1 mg/kg, PO q12h) for feline hypersensitivity dermatitis and inflammatory bowel disease for 1 year, wherein prednisolone was withdrawn 2 weeks prior to presentation. At presentation, dehydration, hyperglycaemia, ketonaemia, increased fructosamine, glucosuria, ketonuria and metabolic acidosis were observed. The cat was diagnosed with diabetic ketoacidosis (DKA). Immediate treatments with insulin continuous-rate infusion and intravenous fluid therapy were initiated. A serum cyclosporine concentration was >2100 ng/mL, indicating cyclosporine toxicity. Cyclosporine was discontinued immediately. The cat's acidosis and ketonaemia were resolved within a week, allowing a switch from insulin continuous-rate infusion to subcutaneous glargine (1 IU/cat), which was eventually discontinued due to persistent normoglycaemia 12 days after initial presentation. Hyperglycaemia was not observed for 28 days thereafter without insulin, indicating remission of diabetes mellitus. This report suggests that using prednisolone, particularly immune suppressive doses, could be problematic in cats receiving long-term cyclosporine therapy. Additionally, diabetic cats receiving immune-suppressive agents can possibly achieve diabetic remission after surviving DKA through regular monitoring of blood glucose concentration, elimination of prednisolone and intensive blood glucose management.
一只 6 岁已绝育的雌性家短毛猫，主要表现为食欲不振和嗜睡。这只猫因过敏性皮肤炎和炎症性肠病正在接受环孢素（25mg/猫，口服，每 24 小时一次）和泼尼松龙（1mg/kg，口服，每 12 小时一次）治疗，泼尼松龙在就诊前 2 周已停用。就诊时，出现脱水、高血糖、酮血症、血中果糖胺升高、糖尿、酮尿和代谢性酸中毒。该猫被诊断为糖尿病酮症酸中毒（DKA）。立即开始给予胰岛素持续输注和静脉补液治疗。环孢素的血清浓度>2100ng/mL，提示环孢素中毒。立即停用环孢素。猫的酸中毒和酮血症在一周内得到解决，随后从胰岛素持续输注改为皮下甘精胰岛素（1IU/猫），由于初始就诊后 12 天持续血糖正常，最终停用了胰岛素。在没有胰岛素的情况下，随后 28 天内未观察到高血糖，表明糖尿病得到缓解。本报告表明，在接受长期环孢素治疗的猫中使用泼尼松龙，特别是免疫抑制剂量，可能存在问题。此外，接受免疫抑制剂的糖尿病猫在通过定期监测血糖浓度、停用泼尼松龙和强化血糖管理成功存活 DKA 后，有可能实现糖尿病缓解。
