Diabetic Ketoacidosis in Cats: What All Pet Parents Should Know

Diabetic ketoacidosis (DKA) in cats is a life-threatening complication of diabetes that requires immediate emergency veterinary care.  

It happens when a cat’s body doesn’t have enough insulin and begins breaking down fat for energy, leading to dangerous acid buildup in the blood. 

Common signs include vomiting, lethargy, dehydration, and a sweet or fruity smell on the breath. Because DKA can worsen quickly—and is often the first sign of undiagnosed diabetes—prompt treatment is critical to saving your cat’s life. 

What is Diabetic Ketoacidosis in Cats?

Diabetic ketoacidosis in cats (also known as DKA) is a medical emergency caused by severe complications of diabetes mellitus.  

DKA can occur when a diabetic feline doesn’t have enough insulin or they develop a secondary medical condition that places additional stress on the cells and the body.  

Both these conditions increase the body’s energy needs, which causes a spike in glucose demand. At this point, the body becomes desperate for energy and will start breaking down fat to acquire an energy source.  

This process leads to the conversion of fat to ketone bodies, which the cells and tissues can use as an alternative energy source.  

However, they create pH and electrolyte imbalances that result in acidosis (too much acid in the blood) and dehydration.  

Unless the normal fuel process is quickly restored (insulin providing glucose to the cells instead of ketones), the body will spiral into a metabolic turmoil that can quickly become life threatening.    

Because diabetes often goes undiagnosed, the symptoms of diabetic ketoacidosis in cats are often the first indication of this underlying condition.  

A pet can also be diabetic (diagnosed or undiagnosed) and not show any symptoms of DKA until a secondary stressor or additional illness develops. 

Symptoms of Diabetic Ketoacidosis in Cats

Symptoms of diabetic ketoacidosis in cats may include: 

• Anorexia   

• Nausea 

• Vomiting   

• Lethargy 

• Depression 

• Weakness  

• Increased drinking and urinating  (sometimes leading to urinary accidents) 

• Increased respiratory rate that can progress to slow, deep breathing (from acidosis)   

• Weight loss 

• Dehydration   

• Unkempt coat/lack of grooming 

• Sweet smell to the affected cat’s breath  

Causes of Diabetic Ketoacidosis in Cats

 Some of the common causes of diabetic ketoacidosis in cats include:   

• Unregulated diabetes mellitus (not getting enough insulin)  

• Pancreatitis 

• Any infection (most commonly urinary tract infection)   

• Fatty liver (hepatic lipidosis) 

• Kidney disease 

• Neoplasia/cancer 

• Any other secondary medical condition that increases metabolic needs or stresses the body   

  • Anorexia or decreased caloric intake 

  • Endocrine problems such as Cushing’s disease or acromegaly 

  • Certain medications such as high-dose corticosteroids (ex: prednisolone) 

  • Unspayed females  

How Veterinarians Diagnose Diabetic Ketoacidosis in Cats

Diagnosing diabetic ketoacidosis in cats will begin with a physical examination, performed by your veterinarian or an emergency vet.  

If your pet is known to have diabetes, the veterinarian may already be suspicious of DKA. The ketones may cause a distinct sweet smell to the pet’s breath.    

The veterinarian will want to run blood work, including a serum chemistry and complete blood count (CBC) panel to assess blood sugar, electrolytes, and any other underlying diseases such as kidney or liver disease.  

Urinalysis will be important to determine if there are signs of glucose and ketones in the urine and to rule out urinary tract infection. Ketones may also be found in the blood serum.    

Once the affected cat is determined to be diabetic and their blood shows the presence of ketones, the focus moves to determining if there is a concurrent disease in addition to the diabetes that led to the DKA.   

At this point, cats will likely be transferred to a 24-hour specialty/emergency hospital for advanced diagnostics and hospitalization. The veterinary staff will likely perform an abdominal ultrasound to assess the pancreas for signs of inflammation (pancreatitis), and they will also assess the liver, kidneys, bladder, and other organ systems for signs of disease or tumors.   

Chest X-rays may also be considered to rule out any evidence of pneumonia (source of infection) or metastasis (evidence of cancer). Finally, a blood-gas analysis may be performed to determine the severity of the acidosis.    

Treatment of Diabetic Ketoacidosis in Cats

Treatment for diabetic ketoacidosis in cats is aimed at removing the ketones from the blood and urine as well as correcting the high blood glucose levels and other electrolyte changes. 

Any underlying cause needs to be treated and the current symptoms they are having, such as vomiting and not eating.  

Intravenous (IV) fluids mixed with regular insulin are given initially before switching back to the regular under the skin injections of insulin.  

Infections are typically treated with antibiotics such as Clavamox.  

The vet team will also address your cat’s symptoms by giving anti-nausea medications (ondansetron or Cerenia) and a special low-fat and low-carbohydrate diet such as Hill’s w/d. 

Recovery and Management of Diabetic Ketoacidosis in Cats

Early diagnosis and treatment of diabetic ketoacidosis in cats is important for the best possible outcome and minimal complications. Most cats will need to remain hospitalized two to seven days and given:  

• IV fluids 

• Anti-nausea medications 

• Electrolyte supplements 

• IV insulin therapy 

• Other supportive care 

Cats are typically discharged once they are eating on their own with no vomiting; they can then get long-acting insulin at home. 

Once the immediate concerns and risks associated with DKA have been corrected (including stopping dehydration, correcting electrolyte abnormalities, and eliminating ketones) the focus shifts to regulating and managing the diabetes mellitus and any concurrent illness.  

This will include starting regular insulin injections under the skin and a special strict diet, specifically for cats with diabetes. This can include Hill’s w/d or Royal Canin Veterinary Diet Adult Glycobalance Dry Dog Food.  

Keeping your cat at a healthy weight and avoiding obesity is essential to cats living with diabetes, especially if they have experienced DKA.