3. Answer all parts of this question:
a) Discuss glucagon’s role in the pathophysiology of diabetic ketoacidosis (DKA).
(6 marks)
b) Describe synthetic pathways of each of the ketones. Include in your answer the
names of the three (3) ketones. (3 marks)
c) The nitroprusside reaction test is used to detect ketones in blood, plasma and
urine. Explain how the nitroprusside reaction test can be negative despite the
presence of ketones in the sample. (2 marks)
d) Patients with diabetic ketoacidosis are described as having a high anion gap
(normochloraemic) metabolic acidosis.
Answer all parts of this sub-question:
i. Provide the formula for anion gap. (1 mark)
ii. Serum bicarbonate is expected to decrease in the presence of elevated
serum anions. Explain why this occurs. (1 mark)
iii. List four (4) other causes of high anion gap metabolic acidosis.
(4 marks)
e) Describe the pathophysiology of pseudohyponatraemia. Include in your answer,
the expected degree of decrease in sodium, relative to increase in glucose.
(6 marks)
f) You are treating a dog with diabetic ketoacidosis with the following laboratory
values:
Na+
: 132 mmol/L
Cl-
: 106 mmol/L
K
+
: 5.2 mmol/L
blood glucose: 38.5 mmol/L
For this patient, calculate the following two values. Show all workings:
i. corrected sodium (3 marks)
ii. corrected chloride. (3 marks)
Question 3 continued over page
Veterinary Emergency Medicine and Critical Care Paper 2 Page 5 of 7
© 2016 The Australian and New Zealand College of Veterinary Scientists ABN 00 50 000894 208
g) List four (4) reasons for hyperkalaemia associated with diabetic ketoacidosis.
(2 marks)
h) Discuss the mechanisms by which insulin therapy and fluid therapy decreases
serum potassium and phosphorus. (2 marks)
i) Severe hypophosphataemia (< 0.3 mmol/L) is a possible complication of the
treatment of diabetic ketoacidosis.
Answer both parts of this sub-question:
i. Describe two (2) effects of severe hypophosphataemia on the red blood
cells and the possible clinical consequences. (2 marks)
ii. List two (2) effects of severe hypophosphataemia on the
neuromuscular system. (1 mark)
j) Outline a general approach to initial fluid therapy and potassium
supplementation in patients with diabetic ketoacidosis. Include in your answer
the type(s) of fluid you would use (for example, isotonic). (7 marks)
k) Outline a general approach to insulin therapy in patients with diabetic
ketoacidosis. (5 marks)
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