A case of euglycaemic diabetic ketoacidosis in pregnancy—a reply

Deepak, Desh; Ingham, Danielle; Reynolds, Rebecca M.; Walker, James

doi:10.1046/j.1464-5491.2002.00688_3.x

Cited by 5 publications

(4 citation statements)

References 1 publication

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“…21,29 Starvation resulting from poor nutritional status or persistent vomiting leads to reduced carbohydrate intake and both have been associated with the development of diabetic ketoacidosis in euglycemic diabetic pregnant women. 25,30,31 Furthermore, it has been suggested that the development of diabetic ketoacidosis and starvation in the pregnant type 1 diabetic with eating disorders may not be rare. 32 In addition, the increased minute alveolar ventilation places the pregnant woman in a state of respiratory alkalosis and is counterregulated by increased renal excretion of bicarbonate.…”

Section: Metabolic Considerations Unique To Pregnancymentioning

confidence: 98%

“…22 Furthermore, diabetic pregnant women are more sensitive to starvation, infection, and extrinsic ketogenic factors such as excessive alcohol intake. 25 The maternal metabolic rate increases by approximately 300 kcal/d in the third trimester. 26,27 Maternal ketone body levels during fasting are elevated by 33% during the third trimester as compared with the postpartum state.…”

Section: Metabolic Considerations Unique To Pregnancymentioning

confidence: 99%

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Diabetic Ketoacidosis in Pregnancy

Sibai

Viteri

2014

Obstetrics &Amp; Gynecology

114

112

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Pregnancies complicated by diabetic ketoacidosis are associated with increased rates of perinatal morbidity and mortality. A high index of suspicion is required, because diabetic ketoacidosis onset in pregnancy can be insidious, usually at lower glucose levels, and often progresses more rapidly as compared with nonpregnancy. Morbidity and mortality can be reduced with early detection of precipitating factors (ie, infection, intractable vomiting, inadequate insulin management or inappropriate insulin cessation, β-sympathomimetic use, steroid administration for fetal lung maturation), prompt hospitalization, and targeted therapy with intensive monitoring. A multidisciplinary approach including a maternal-fetal medicine physician, medical endocrinology specialists familiar with the physiologic changes in pregnancy, an obstetric anesthesiologist, and skilled nursing is paramount. Management principles include aggressive volume replacement, initiation of intravenous insulin therapy, correction of acidosis, correction of electrolyte abnormalities and management of precipitating factors, as well as monitoring of maternal-fetal response to treatment. When diabetic ketoacidosis occurs after 24 weeks of gestation, fetal status should be continuously monitored given associated fetal hypoxemia and acidosis. The decision for delivery can be challenging and must be based on gestational age as well as maternal-fetal responses to therapy. The natural inclination is to proceed with emergent delivery for nonreassuring fetal status that is frequently present during the acute episode, but it is imperative to correct the maternal metabolic abnormalities first, because both maternal and fetal conditions will likewise improve. Prevention strategies should include education of diabetic pregnant women about the risks of diabetic ketoacidosis, precipitating factors, and the importance of reporting signs and symptoms in a timely fashion.

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Section: Metabolic Considerations Unique To Pregnancymentioning

confidence: 98%

Section: Metabolic Considerations Unique To Pregnancymentioning

confidence: 99%

Diabetic Ketoacidosis in Pregnancy

Sibai

Viteri

2014

Obstetrics &Amp; Gynecology

114

112

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“…Previous reports suggest that DKA may appear even with a normal serum glucose level. We presented two cases of euglycemic ketoacidosis in pregnancy reported 24,25 with clinical data and sequel listed in Table 2. Short term fasting was thought to be a mechanism for the development of euglycemic DKA 26 .…”

Section: Discussionmentioning

confidence: 99%

Diabetic ketoacidosis in pregnancy tends to occur at lower blood glucose levels: Case–control study and a case report of euglycemic diabetic ketoacidosis in pregnancy

Guo¹,

Lingzhu²,

Li³

et al. 2008

J of Obstet and Gynaecol

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“…The presentation is similar to hyperglycaemic cases with a history of dyspnoea, nausea and vomiting sometimes preceded by infection 14. Patients usually have gestational diabetes mellitus (GDM) or the development of ketoacidosis leads to the diagnosis of GDM 15, 16. Ketoacidosis is rare in insulin‐treated diabetic pregnancy 17.…”

Section: Clinical Syndromes and Their Managementmentioning

confidence: 99%

Euglycaemic ketoacidosis in patients with and without diabetes

2013

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Ketoacidosis in individuals with diabetes is usually associated with a raised plasma glucose concentration. However, ketoacidosis in diabetes can occur with normal (≤11mmol/L) plasma glucose levels. Ketoacidosis is also seen in patients who do not have diabetes, most commonly in pregnancy or following alcoholic binges, rarely with starvation, anorexia nervosa or inborn errors of metabolism. The aim of this review is to compare the clinical features, pathophysiology and management of these conditions. Common clinical features due to a raised anion gap metabolic acidosis are seen. Reduced carbohydrate intake is a usual contributor to ketogenesis. Treatment is primarily with intravenous glucose, insulin if there is insulin deficiency and potassium as needed. The value of using bedside monitors to measure β-hydroxybutyrate levels both for diagnosis and monitoring of response to treatment is emphasised. Early recognition of ketoacidosis and treatment with glucose rather than saline is important for optimum outcome.

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A case of euglycaemic diabetic ketoacidosis in pregnancy—a reply

Cited by 5 publications

References 1 publication

Diabetic Ketoacidosis in Pregnancy

Diabetic Ketoacidosis in Pregnancy

Diabetic ketoacidosis in pregnancy tends to occur at lower blood glucose levels: Case–control study and a case report of euglycemic diabetic ketoacidosis in pregnancy

Euglycaemic ketoacidosis in patients with and without diabetes

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