Eating disorders and diabetic ketoacidosis in a pregnant woman with type 1 diabetes: A case report

Napoli, Angela; Framarino, Marialuisa; Colatrella, Antonietta; Merola, Gianluca; Trappolini, M; Toscano, Vincenzo; Talucci, V.; Iafusco, Dario

doi:10.1007/bf03325322

Cited by 14 publications

(9 citation statements)

References 15 publications

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“…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. This results in a lowered buffering capacity, which further contributes to the development of diabetic ketoacidosis at lower glycemic levels than those seen in nonpregnant patients.…”

Section: Metabolic Considerations Unique To Pregnancymentioning

confidence: 99%

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: 99%

Diabetic Ketoacidosis in Pregnancy

Sibai

Viteri

2014

Obstetrics &Amp; Gynecology

114

112

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“…Of the 17 included studies, 15 studies addressed the use of CSII in people with T1DM and disordered eating. 11,12,[34][35][36][37][38][39][40][41][42][43][44][45][46] Three studies referred to CGM (two of which also addressed CSII), 38,39,47 and one study referred to the use of AID in people with T1DM and disordered eating 48 (Table 1). Fourteen studies, thirteen with observational and one with controlled design, were eligible for quality assessment.…”

Section: Resultsmentioning

confidence: 99%

“…Fourteen studies, thirteen with observational and one with controlled design, were eligible for quality assessment. Two case studies 40,41 and one review 48 included in our synthesis were not assessed in terms of their quality. Eight studies were classified as having a moderate risk of bias.…”

Section: Resultsmentioning

confidence: 99%

Diabetes technologies in people with type 1 diabetes mellitus and disordered eating: A systematic review on continuous subcutaneous insulin infusion, continuous glucose monitoring and automated insulin delivery

et al. 2021

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“…Generally, it is recommended to continue the pregnancy while attempts are made to identify and correct the physiologic derangement. Typically, once the acidosis is corrected, fetal abnormalities improve [4, 12– 16]. Emergent cesarean delivery should only be attempted if the maternal condition worsens, but this is associated with high maternal morbidity and mortality.…”

Section: Discussionmentioning

confidence: 99%

Euglycemic Diabetic Ketoacidosis in Pregnancy: A Case Report and Review of Current Literature

Jaber

Standley

Reddy

2019

Case Reports in Critical Care

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Diabetic ketoacidosis (DKA) in pregnancy is associated with high fetal mortality rates. A small percentage of DKA occurs in the absence of high glucose levels seen in traditional DKA. Prompt recognition and management is crucial. We report a case of a 30-year-old pregnant woman with type 1 diabetes mellitus admitted with euglycemic DKA (blood glucose <200 mg/dL). Initial laboratory testing revealed a severe anion gap acidosis with pH 7.11, anion gap 23, elevated β-hydroxybutyric acid of 9.60 mmol/L, and a blood glucose of 183 mg/dL—surprisingly low given her severe acidosis. The ketoacidosis persisted despite high doses of glucose and insulin infusions. Due to nonresolving acidosis, her hospital course was complicated by spontaneous intrauterine fetal demise. Euglycemia and severe acidosis continued to persist until delivery of fetus and placenta occurred. It was observed that the insulin sensitivity dramatically increased after delivery of fetus and placenta leading to rapid correction of ketoacidosis. This case highlights that severe ketonemia can occur despite the absence of severely elevated glucose levels. We discuss the mechanism that leads to this pathophysiologic state and summarize previously published case reports about euglycemic DKA in pregnancy.

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Eating disorders and diabetic ketoacidosis in a pregnant woman with type 1 diabetes: A case report

Abstract: We suggest that pregnancy in T1DM women with eating disorders may not be rare. The prevention, early recognition and aggressive management of DKA can minimise the possible complications, and is mandatory for the safety of the fetus and mother.

Cited by 14 publications

References 15 publications

Diabetic Ketoacidosis in Pregnancy

Diabetic Ketoacidosis in Pregnancy

Diabetes technologies in people with type 1 diabetes mellitus and disordered eating: A systematic review on continuous subcutaneous insulin infusion, continuous glucose monitoring and automated insulin delivery

Euglycemic Diabetic Ketoacidosis in Pregnancy: A Case Report and Review of Current Literature

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