Deep dive into insulin CRI for dogs and cats with diabetic ketoacidosis (DKA)

[@vetvoovlog1243]

Thank you for the information. I also thought this protocol might lead to human errrors, especially wehn working in defferent settings from daily practice. This might be a little bit of topic but I have question. In cats with DM, sometimes we see hypoglycemic cats due to the overdose of insulin. A CASE: A cat had one or two seizure before presentation with hypoglycemia At first presentation, the low blood gulcose (30mg/dl or 1.6-1.7mmol/L), bradycardia, and weak pluse are observed. TFAST showed the lack of cardiac function: No Hx of cardiac diseases. I imagine cardiac shock caused by hypoglycemia(Or could we say metabolic shock?) might have happened in this case. My coworker had sticked to place a catheter to bolus and CRI of dextrose. It took more than 40 mins to complete it because he had difficulty finding vein at any place. I knew hypoglycemia would continue and the following CRI of dextrose is necessary. But it took too much time.😅 A cut-down catheter is one way. QUESTION is here: However, I suppose a temporal dextrose treatment can help restore cardiac function temporarily, such as oral mucosal application IV from jugular vein with butterfly needle, leading t making us easier to place the catheter later. My coworker afraid of aspiration and refused to give oral dextrose. I was not in charge of the case. So I could no interfere further. What do you think about applying dextrose in the gum or taking advantage of jugular vein beforehand?

[@vetemcrit]

Hi there! Thanks for sharing your case. Using concentrated (40-50%) dextrose transmucosally (i.e. via gums) can indeed be a potential temporary solution to manage hypoglycemia while establishing a venous or intraosseous access. As long as you are applying only 0.1-0.3 ml of dextrose at a time, the risk of aspiration will be minimal since the volume is so low. That said, your number one goal should be to establish a venous access as soon as possible. If peripheral veins are not accessible, using a jugular vein or performing a cut-down will make sense. A regular intravenous catheter can be placed into a jugular vein and then exchanged to a central line (via guide wire) later. You can also learn on how to place intraosseous catheters or needles that may take less than a minute to place (link - kzbin.info/www/bejne/Z2HXqIGPhZajeJIsi=i9mh-Ku-d_IuH9K6). Also, if you need more mentorship, you can join the VETEMCRIT Academy here - academy.vetemcrit.com/courses

[@vetvoovlog1243]

​@@vetemcrit Thank you for the answer and the video link. Yeah, I will start with the trial course, then I will go with the next, probably monthly plan. By the way, could we say this bradycardia is caused by hypoglycemia when any other causes of bradycardia are not observed and both of the heart rate and the blood pressure in the cat are normalized after the injection of dextrose?

[@vetemcrit]

@@vetvoovlog1243 yes, absolutely bradycardia can be caused by severe hypoglycemia in a cat.

[@vetvoovlog1243]

@@vetemcrit Thank you. I knew it, and now I got confident. I will tell this to my coworkers. By the way, I started the free trial. I will watch them little by little.