Hypoglycemia Associated with Ketosis in Bitches in the Final Phase of Gestation

Abstract

Background: 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.