Tyrosine‐derived 4‐hydroxyphenylpyruvate reacts with ketone test fields of 3 commercially available urine dipsticks

Background: The enzyme 4‐hydroxyphenylpyruvate dioxygenase (HPPD) is key in tyrosine catabolism. Inhibition of HPPD results in tyrosinemia and increased urinary excretion of 3 phenylketones: 4‐hydroxyphenylpyruvate (HPPA), 4‐hydroxyphenyllactate (HPLA), and 4‐hydroxyphenylacetate (HPAA). A previous study involving administration of a novel HPPD inhibitor to dogs resulted in detection of ketonuria in treated animals using urine dipsticks read by reflectance photometry. Dipstick‐positive results were suspected to be false because high concentrations of urinary phenylketones have been reported to react with ketone test fields of urine dipsticks, but visual confirmation was not performed. Objective: The purpose of this study was to determine which of the 4‐hydroxyphenolic acids produced by HPPD inhibition react with ketone test fields of 3 commercially available urine dipsticks. Methods: Canine urine samples were prepared with HPPA, HPLA, HPAA, and lithium acetoacetate (positive control) at 6 concentrations. Unmodified urine samples were used as negative controls. All samples were tested for ketones using Combur 10 Test M dipsticks read by a Miditron dipstick analyzer. Urinalysis was also performed by visually inspecting ketone test fields on the Combur 10 Test M, Multistix 10 SG, and Aution 10 EA dipsticks. Results: Urine samples containing HPPA were positive for ketones with Combur 10 Test M dipsticks read by the Miditron analyzer and produced a red–brown color change in ketone test fields of all 3 dipsticks. Urine samples containing HPLA and HPAA were negative by all methods. Conclusion: The phenylketone HPPA reacts with ketone test fields of 3 commercially available urine dipsticks, producing a red–brown color change that may be misinterpreted as positive for ketones by reflectance photometry.     

Evaluating the use of plasma hematocrit samples to detect ketones utilizing urine dipstick colorimetric methodology in diabetic dogs and cats

Objective: To determine whether plasma from a heparinized hematocrit tube placed on a urine dipstick would accurately reflect (positive or negative) urine ketone results in diabetic dogs and cats. Design: Prospective study, 37 dogs and 43 cats, with a known history of diabetes or hyperglycemia, glucosuria, and symptoms of undiagnosed diabetes mellitus were tested. Setting: Veterinary Referral Hospital. Animals: Client owned dogs and cats. Interventions: None. Measurement and main results: Heparinized plasma and urine ketone results were recorded using urine reagent strips. Plasma dipstick results were compared to urine dipstick results as the standard. Results were recorded based on the color chart provided by the manufacturer. Two individuals were responsible for verifying the results of the colorimetric test. Test efficiency was 97% (sensitivity = 96%, specificity = 100%) for the canine population, 93% (sensitivity = 100%, specificity = 83%) for the feline population, and 95% (sensitivity = 98%, specificity = 91%) for the total population. Four of 80 animals were found to have discordant results (1 dog and 3 cats). Conclusion: Plasma from heparinized hematocrit tubes is clinically useful for detecting the presence or absence of ketonuria, and therefore ketosis, in diabetic dogs and cats using urine dipstick colorimetric methodology.     

Organic acidemia in a young cat associated with cobalamin deficiency

Objective: To describe a case of severe metabolic acidosis and encephalopathy secondary to cobalamin (Cbl) deficiency in a young cat. Case summary: A 4‐year‐old spayed female domestic short hair cat weighing 2.5 kg, presented with a 2‐day history of neurological signs referable to the cerebrum. The cat was evaluated for similar episodes twice before, however, no definitive diagnosis was made for either visit. On presentation the cat was minimally responsive and had a metabolic acidosis and ketonuria with no apparent reason, such as lactic acidosis or diabetic ketoacidosis. The patient was diagnosed postmortem with an organic acidemia secondary to low Cbl levels. New or unique information provided: The purpose of this report is to alert emergency clinicians to be suspicious of an organic acidemia in any case of metabolic acidosis and ketonuria that cannot be explained. Early identification of inherited organic acidemias in domestic animals may allow prompt and appropriate treatment of these conditions.