A case of euglyacemic diabetic ketoacidosis in a patient with gestational diabetes mellitus

Graham, Una; Cooke, Inez; McCance,

doi:10.1177/1753495x14547558

Cited by 7 publications

(3 citation statements)

References 16 publications

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“…In addition, we demonstrated a more pathologic FHR pattern III intrapartum as maternal ketonuria progressed, which was consistent with a previous study showing that abnormal fetal heart physiology in the setting of postterm pregnancy was related to maternal ketonuria [6]. Additional support for our results comes from recent studies reporting pathologic fetal heart tracings in the presence of extreme quantities of ketone bodies, such as those in diabetic ketoacidosis (DKA), starvation ketoacidosis (SKA), and euglycemic diabetic ketoacidosis (EDKA) [21, 22]. Our data also depicted an increased incidence of FHR pattern III as the durations of both moderate ketonuria and ketosis were prolonged, especially when the duration of ketosis was >4 h. Based on our results, we recommend enhanced FHR monitoring during the second stage of labor in pregnant women with both moderate ketonuria and ketosis.…”

Section: Discussionsupporting

confidence: 91%

Intrapartum Results on Differing Degrees of Ketonuria in Nulliparous Women with Gestational Diabetes Mellitus during Spontaneous Labor

Huang

et al. 2019

International Journal of Endocrinology

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To compare intrapartum results associated with differing degrees of ketonuria in nulliparous women with gestational diabetes mellitus (GDM), we implemented a retrospective cohort study comparing clinical characteristics among differing degrees of ketonuria and the duration and distribution of ketonuria at different stages of labor. We also analyzed adverse maternal and neonatal outcomes for each group. A total of 570 GDM deliveries were included; of these, 238 had negative ketonuria (41.8%), 180 had moderate ketonuria (31.6%), and 152 had ketosis (26.6%). The proportion of patients with a family history of diabetes significantly increased as the degree of ketonuria increased (P < 0.001). Moreover, a significantly lower level of HOMA-IR (the insulin resistance index) was observed for the Negative group (P < 0.001). The triglyceride (TG) level was significantly higher in the Ketosis group (P < 0.001), and the total cholesterol (TC) levels significantly increased as the degree of ketonuria progressed (P < 0.001). There were also higher maternal blood sugar levels and a significantly higher proportion of oxytocin augmentation in ketonuria cases (P < 0.001). Over three-fourths of patients (75.6%) had a ketonuria duration of ≤2 hours in the Moderate group, 61.2% had a ketonuria duration of between 3 and 4 h in the Ketosis group, and most of the ketonuria cases resolved in the first stage of labor. As the degree of ketonuria progressed, we observed a significantly higher number of cases with fetal heart rate pattern III (FHR pattern III), meconium-stained amniotic fluid III (MSAF III), postpartum hemorrhages, prolonged labor, neonatal hypoglycemia, an umbilical cord arterial pH of <7.2, low Apgar scores, increased neonatal intensive care admissions, augmented forceps-assisted deliveries, and conversions to cesarean sections. The results showed that ketonuria is common during the intrapartum period and that the risk of adverse maternal and neonatal outcomes may increase when complicated with ketonuria.

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Section: Discussionsupporting

confidence: 91%

Intrapartum Results on Differing Degrees of Ketonuria in Nulliparous Women with Gestational Diabetes Mellitus during Spontaneous Labor

Huang

et al. 2019

International Journal of Endocrinology

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“…Euglycemic DKA has been reported in women with both pregestational (T1DM and T2DM) and gestational diabetes [5,6,10,11,13]. Even in cases of euglycemia, DKA remains a medical emergency that needs urgent and proper management [14].…”

Section: Discussionmentioning

confidence: 99%

Diagnosis and Management of Euglycemic Diabetic Ketoacidosis in a Young Pregnant Woman with Type 1 Diabetes Mellitus

2018

JCRC

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Diabetic ketoacidosis (DKA) is a medical emergency in diabetes patients that needs urgent management. Because of the physiologic changes during pregnancy, pregnant women with diabetes are at a high risk of developing euglycemic DKA. Euglycemia could distract the treating physician from the early diagnosis and management of DKA, leading to fatal consequences for the mother, as well as the fetus. Here, we describe the case of a young pregnant woman with type 1 diabetes mellitus who was diagnosed with euglycemic DKA. She was successfully treated with an insulin infusion, dextrose 10% in water (D10W) intravenously, and potassium replacement.

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“…At least 18 cases of pregnant women with severe ketoacidosis and normal blood glucose are reported in the literature. 2,[14][15][16][17][18][19][20][21][22][23][24][25][26][27] The majority of these cases were precipitated by a short period of reduced oral intake and vomiting. Abdominal pain was also frequently reported in these patients.…”

Section: Ketoacidosis In Pregnancymentioning

confidence: 99%

Pregnancy and ketoacidosis: Is pancreatitis a missing link?

et al. 2015

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Non-diabetic ketoacidosis is increasingly recognised in pregnancy, particularly during the third trimester, and is usually associated with vomiting. In many cases, the cause of the vomiting is not identified and resolves rapidly, alongside the metabolic abnormalities, following delivery. Here, we report three cases in which pancreatitis was identified as an underlying cause of the gastrointestinal symptoms. To our knowledge, these are the first reports of pancreatitis precipitating non-diabetic ketoacidosis in pregnancy. This case series highlights the importance of searching for a precipitant for non-diabetic ketoacidosis in pregnancy, rather than focusing solely on management of the resulting metabolic abnormalities.

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A case of euglyacemic diabetic ketoacidosis in a patient with gestational diabetes mellitus

Cited by 7 publications

References 16 publications

Intrapartum Results on Differing Degrees of Ketonuria in Nulliparous Women with Gestational Diabetes Mellitus during Spontaneous Labor

Intrapartum Results on Differing Degrees of Ketonuria in Nulliparous Women with Gestational Diabetes Mellitus during Spontaneous Labor

Diagnosis and Management of Euglycemic Diabetic Ketoacidosis in a Young Pregnant Woman with Type 1 Diabetes Mellitus

Pregnancy and ketoacidosis: Is pancreatitis a missing link?

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