NAVLE Emergency Guide
DKA Approach in Dogs and Cats: Stabilization Before Insulin
DKA management is a sequencing problem: fluids first, electrolyte safety, then controlled insulin strategy. This guide emphasizes decision order and reassessment points that frequently appear in NAVLE-style questions.
Use this guide to move from first-pass pattern recognition to structured diagnostic and treatment logic. The flow is designed for NAVLE-style decision sequencing and practical ward preparation.
Rapid Algorithm
- Confirm likely DKA pattern using compatible history, hyperglycemia, ketone evidence, and acid-base derangement.
- Stabilize perfusion first with isotonic fluids and clinical reassessment.
- Evaluate potassium and electrolytes before insulin initiation whenever possible.
- Start insulin infusion using structured glucose and electrolyte monitoring intervals.
- Treat trigger conditions while adjusting therapy according to response trajectory.
Diagnostic Flow
- Serial glucose, potassium, and acid-base trends guide safe transitions in therapy intensity.
- Urinalysis and ketone assessment help confirm and monitor metabolic resolution direction.
- Baseline chemistry supports interpretation of dehydration, azotemia, and electrolyte deficits.
- CBC and focused infection workup can identify concurrent inflammatory triggers.
- Trend mentation and hydration markers alongside lab values to avoid tunnel vision.
Treatment Flow
- Use fluid resuscitation to improve perfusion before aggressive metabolic correction.
- Replace potassium proactively according to serial lab and ECG-informed risk assessment.
- Begin insulin using controlled infusion protocols after initial stabilization steps.
- Add dextrose support when glucose falls into target transition range during insulin therapy.
- Address concurrent disease drivers such as pancreatitis, infection, or endocrine stressors.
Exam Traps
- Starting insulin before correcting or planning potassium support is a common critical error.
- Assuming glucose normalization equals DKA resolution can miss persistent ketotic acidosis.
- Large fluid shifts without reassessment may worsen neurologic and perfusion risk.
- Ignoring concurrent trigger disease reduces long-term stability and recurrence prevention.
- Failing to define monitoring intervals creates avoidable therapy drift.
Practice Prompts
- Why is fluid-first sequencing central in DKA stabilization?
- How should potassium trends alter insulin decision timing?
- When is dextrose added during insulin infusion protocols?
- Which findings suggest DKA is improving versus partially corrected?
- How do concurrent trigger diseases affect recurrence risk?
Related Content
- Return to pillar: NAVLE Emergency and Critical Care: Triage, Stabilize, Treat
- Heatstroke in Dogs and Cats: Controlled Cooling and Critical Monitoring
- Veterinary Transfusion Basics: Product Choice, Monitoring, and Reactions
- Use the Insulin CRI Planner
- Try 5 free practice questions on this topic
- Unlock unlimited practice (Premium)
Sources and Review Notes
- Drug label search (DailyMed)
- IRIS stages
- Normal lab values
- Heartworm treatment protocol
- Lab test protocols
- Microchip lookup
- Vertebral Heart Score
- BCS charts
- ACVIM cardiology consensus guideline references
- Dental charts
- AAHA vaccination guidelines
- Flea/tick product info
- Dog/cat breed search
- RECOVER CPR guidelines
Last reviewed: February 13, 2026
Educational only. This page is designed for study and does not replace case-specific diagnosis, local protocols, or direct supervision.