Hypoglycemia Associated with Ketosis in Bitches in the Final Phase of Gestation
AbstractBackground: Pregnancy toxemia is a metabolic disorder characterized by hypoglycemia and ketonemia, resulted from the inability of the animal to maintain an adequate energetic balance associated with increased corporal fat mobilization to supply energetic requirement, that can place the health and life of the bitch and their fetus at risk. Despite well recognized in sheep as pregnancy toxemia and in women as preeclampsia, hypoglycemia and ketosis is an uncommon condition in bitches. Apparently, five documented cases have been published since 1964. The objective of this work is to discuss clinical cases of hypoglycemia and ketosis.
Cases: Two cases of gestational ketosis in bitches on late gestational phase are reported. Case 1. In the first one, a small bitch was presented in labor, with fetus insinuation, prostration, dehydration, pale mucous membranes with laboratorial signs of normochromic and normocytic anemia and anisocytosis, signals of fetal distress in abdominal ultrasonography, hypoglycemia (43 mg/dL) and ketonemia (3.6 mmol/L). Therapeutic course consisted of correction of dehydration and 50% glucose replacement at the dose of 0.5 mg / kg, followed by caesarean section and ovariohysterectomy. Except for the insinuated fetus, all the five remainings were born alive and survived, and the post-surgical recovery occurred without complications. Case 2. The second case involved a small 55-day pregnant bitch, presenting depression, apathy, anorexia, dehydration, abdominal distention compatible with final third of pregnancy without delivery signs. There were signs of fetal distress at ultrasonographic examination, with depression and lack of responses to mechanical stimuli. Laboratory findings include microccytic hypochromic anemia, hypoglycemia (31 mg/dL) and ketonemia detected by urinalysis reagent tape. Three hours after intravenous administration of 50% glucose at the dose of 1.0 mg/kg, the animal was alert and nourished. Upon repeated ultrasonography, fetuses had normal heartbeats, with adequate response to mechanical stimuli. Dietary correction was recommended and after one week the bitch gave birth to six pups, three of them survived and stayed healthy.
Discussion: Pregnancy is a physiological state of intense energy consumption, since the demand for glucose is increased for the supply directed to the uterine and fetal development. Pregnancy hypoglycemia in bitches is a rare condition, since progesterone normally acts as a potent insulin antagonist, reducing the transport of glucose into the cell, resulting in hyperglycemia. Suppression of insulin secretion, as a result of hypoglycemia, promotes the mobilization of stored fat and the release of fatty acids and ketones. In extreme cases the result may be hypoglycemia and ketosis. This combination characterizes pregnancy toxemia, an unusual finding in bitches. The main clinical manifestation is depression and anorexia, and the diagnosis is confirmed by the demonstration of ketonuria without glycosuria associated with hypoglycemia. The treatment for hypoglycemic crisis consists of immediate correction of hypoglycemia, by intravenous administration of 50% glucose at a dose of 0.5 to 1 mL / kg, as well as the correction of hydroelectrolytic and dietary disorders. Rapid diagnosis and treatment are critical to preserving maternal and fetal health. This is a metabolic disorder with pathophysiological bases that have not yet been completely clarified.
Keywords: gestational ketoacidosis, bitches, preparturient hypoglycaemia.
Batista M.R., Smith M.S., Snead W.L., Connolly C.C., Lacy D.B. & Moore M.C. 2005. Chronic estradiol and progesterone treatment in conscious dogs: effects on insulin sensitivity and response to hypoglycemia. American Journal of Physiology- Regulatory, Integrative and Comparative Physiology. 289(4): 1064-1073.
Black R.E. 2001. Micronutrients in pregnancy. British Journal of Nutrition. 85(2): 193-197.
Canniff K.M., Smith M.S., Lacy D.B., Williams P.E. & Moore M.C. 2006. Glucagon secretion and autonomic signaling during hypoglycemia in late pregnancy. American Journal of Physiology- Regulatory, Integrative and Comparative Physiology. 291(3): 788-795.
Chastain C.B. 1981. Intensive care of dogs and cats with diabetic ketoacidosis. Journal of the American Veterinary Medical Association. 170(10): 972-978.
Duarte R. 2002. Accuracy of serum â-hydroxybutyrate managements for the diagnosis of diabetic ketoacidosis in 116 dogs. Journal of Veterinary Internal Medicine. 16(4): 411-417.
Feldman E.C. & Nelson R.W. 2004. Canine Diabetes Mellitus. In: Canine and feline endocrinology and reproduction. 3rd edn. Phladelphia: Elsevier, pp.486-538.
Figueiredo T.C.F., Poletto D., Sousa V.R.F., Mendonça A.J. & Almeida A.B.P.F. 2016. Concentração sérica de glicose, colesterol, triglicerídeos e frutosamina em cadelas gestantes. Acta Veterinaria Brasilica. 10(2): 182-185.
Ghaffari M.S. & Najafiyan H.R. 2009. Diagnosis and management of preparturient hypoglycemia in a Great Dane bitch. Comparative Clinical Pathology. 18(4): 467-468.
Handcock W.J. 1978. Hypoglycaemia in a pregnant bitch. Journal of South Africa Veterinary Association. 49(1): 69.
Hardy R.M. 1988. Diabetes mellitus en el perro y en el gato. Revista de la Asociación de Veterinarios Españoles Especialistas en Pequeños Animales. 8(2): 71-88.
Irvine C.H.G. 1964. Hypoglycaemia in the bitch. New Zealand Veterinary Journal. 12(6): 140-144.
Jackson R.F., Bruss M.L., Growney P.J. & Seymour W.G. 1980. Hypoglycemia-ketonemia in a pregnant bitch. Journal of the American Veterinary Medical Association. 177(1): 1123-1127.
Johnson C.A. 2008. Glucose homeostasis during canine pregnancy: Insulin resistance, ketosis, and hypoglycemia. Theriogenology. 70(9): 1418-1423.
Johnston S.D., Kustritz M.V.R. & Oslon P.S. 2001. Canine pregnancy. In: Canine and feline theriogenology. Philadelphia:WB Saunders Co., pp.66-104.
Luz M.R., Freitas P.M.C. & Pereira E.Z. 2005. Gestação e parto em cadelas: fisiologia, diagnóstico de gestação e tratamento das distocias. Revista Brasileira de Reprodução Animal. 29(3/4): 142-150.
Macintire D.K. 1993. Treatment of diabetic ketoacidosis in dog by continuous lowdose intravenous infusion of insulin. Journal of the American Veterinary Medical Association. 202(8): 1266-1272.
Moore A.H. & Wotton P.R. 1993. Preparturient hypoglycaemia in two bitches. The Veterinary Record. 133(16): 396.
Solomon C.G & Seely E.W. 2004. Preeclampsia - searching for the cause. The New England Journal of Medicine. 350(7): 641-642.
Walsh S.W. 2007. Obesity: a risk factor for preeclampsia. Trends in Endocrinology and Metabolism. 18(10): 365-70.
Yogev Y., Ben-Haroush A., Chen R., Rosenn B., Hod M. & Langer O. 2004. Diurnal glycemic profile in obese and normal weight nondiabetic pregnant women. American Journal of Obstetrics and Gynecology. 191(3): 949-953.
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