DKA is a moving workflow
The first treatment plan is only the starting point.
Blood glucose may fall while ketosis continues. Potassium and phosphorus can change after fluids and insulin begin. Dextrose may need to be added while insulin continues. In cats receiving an SGLT2 inhibitor, marked hyperglycemia may be absent altogether.
The difficult part is rarely one calculation. It is knowing what the latest result changes next.
Start by confirming the full picture
DKA assessment brings three findings together:
- A diabetic patient with compatible clinical illness.
- Evidence of ketosis.
- Evidence of an acid-base disturbance.
Glucose alone does not confirm or exclude DKA.
This matters especially in cats receiving an SGLT2 inhibitor. These patients may develop euglycemic DKA, with ketosis and acidosis but without the marked hyperglycemia expected in classic DKA.
Keep the medication history, clinical signs, ketone method, and acid-base findings visible from the beginning.
Smart protocols
Working through a patient now?
The Vetool DKA Protocol keeps the current glucose, ketones, acid-base findings, fluid rate, electrolytes, and feline-specific risks in one guided workflow.
Build the initial plan around the patient
The first plan usually needs to account for:
- Perfusion and hydration.
- Ketosis and acid-base status.
- Potassium and phosphorus.
- Insulin and dextrose.
- Concurrent disease.
- Nutrition and monitoring.
Individualize fluid therapy and reassess it against the patient's response. One standard rate will not fit every patient or every stage of the case.
Electrolyte supplementation needs the same care. A bag cannot be assessed from its concentration alone. Patient weight, fluid rate, bag volume, current results, and every electrolyte source affect the finished plan.
This is where the workflow often spreads across calculations, notes, and shift handovers.
Falling glucose does not mean the case is finished
A lower glucose result may be reassuring, but it does not show whether ketosis and the acid-base disturbance have resolved.
As glucose changes, the team may need to reconsider:
- The insulin plan.
- Whether dextrose is required.
- The current potassium and phosphorus results.
- The fluid prescription.
- The timing of the next reassessment.
Insulin and dextrose may be used together because they address different parts of the case.
At each glucose check, ask what the result changes in the current protocol.
Keep feline eDKA on the list
A cat receiving an SGLT2 inhibitor may be ketotic and acidotic while glucose remains below the range expected in classic DKA.
That can make the glucose result falsely reassuring.
When an SGLT2-treated cat becomes unwell, review appetite, vomiting, lethargy, hydration, ketone results, and acid-base findings rather than relying on glucose alone. The 2025 iCatCare and 2026 AAHA feline diabetes guidelines both describe eDKA as an important complication of this drug class.
Where the workflow usually breaks
Glucose becomes the only endpoint
Glucose improves, but ketosis, electrolytes, and the clinical picture are not reassessed together.
The fluid bag and rate become separate decisions
A bag may look appropriate until the patient's weight and current delivery rate are taken into account.
Phosphorus is reviewed on its own
Electrolyte additions can affect more than one part of the finished bag, including the total potassium delivery.
SGLT2 inhibitor use is discovered late
The patient is assessed as though marked hyperglycemia must be present.
Nutrition stays at the bottom of the plan
Poor intake, nausea, electrolyte changes, and refeeding risk can be missed while the team focuses on glucose and fluids.
The plan becomes scattered
The fluid calculation is in one place, insulin instructions are in another, and monitoring times are somewhere else.
What to keep visible at every reassessment
The treatment plan depends on the patient, but the same questions keep returning:
- Is the patient clinically improving?
- Are ketosis and the acid-base disturbance resolving?
- What changed in glucose, potassium, and phosphorus?
- Does the fluid plan still fit the patient?
- Does the insulin or dextrose plan need to change?
- When are the next checks due?
- Has a concurrent problem been identified?
- Is the nutrition plan moving forward?
A usable DKA workflow keeps these decisions connected.
Move from the guide to the patient workflow
Enter the current findings in Vetool for a guided DKA or eDKA assessment, electrolyte bag support, insulin and dextrose actions, feline warnings, and a monitoring checklist. This keeps the protocol together while you review how the patient is responding.
References
- Bugbee A, Rucinsky R, Alvarez E, et al. 2026 AAHA Diabetes Management Guidelines for Cats. doi:10.5326/JAAHA-MS-7572. Read the 2026 AAHA guideline
- Pardo M, Spencer E, Odunayo A, et al. 2024 AAHA Fluid Therapy Guidelines for Dogs and Cats. doi:10.5326/JAAHA-MS-7444. Read the AAHA fluid guideline
- Taylor S, Cannon M, Church D, et al. 2025 iCatCare consensus guidelines on the diagnosis and management of diabetes mellitus in cats. doi:10.1177/1098612X251399103. Read the iCatCare guideline
- Behrend E, Holford A, Lathan P, et al. 2018 AAHA Diabetes Management Guidelines for Dogs and Cats, including updates made in 2022. doi:10.5326/JAAHA-MS-6822. Read the 2018 AAHA guideline
- Taylor S, Chan DL, Villaverde C, et al. 2022 ISFM Consensus Guidelines on Management of the Inappetent Hospitalised Cat. doi:10.1177/1098612X221106353. Read the ISFM nutrition guideline
Disclaimer
For veterinary professional education and workflow support only. This guide does not replace patient-specific assessment, clinical judgment, continuous monitoring, current references, product labeling, or referral when indicated. The attending veterinary professional must confirm all treatment decisions and calculations.