Euglycemic diabetic ketoacidosis in pregnancy with COVID‐19: A case report and literature review

Abstract

Diabetic ketoacidosis (DKA) is a life‐threatening complication of diabetes and is considered a medical emergency. Euglycemic DKA (EKDA) is a variant of DKA with a normal or minimally elevated glucose level <200 mg/dl. The condition can be difficult to diagnose due to the relatively normal glucose levels. Pregnancy, infection, and a low‐calorie intake are some of the contributing common etiologies of EDKA. Despite a rapid increase in scientific publications on COVID‐19, there are still knowledge gaps regarding the course of COVID‐19 in some patient subset. This is especially the case for pregnant women. In this case report, we discuss the course of COVID‐19 infection in a pregnant woman with gestational diabetes who developed severe euglycemic diabetic ketoacidosis triggered by various precipitating factors, including starvation, caused by COVID‐19 infection and its gastrointestinal effects.

Euglycemic diabetic ketoacidosis in the era of SGLT-2 inhibitors

“…Cases of EDKA have been reported in association with anhedonia and anorexia with severe depression33 and in a patient with Prader-Willi syndrome who was on a low-carbohydrate diet and on ipragliflozin 50. Further examples of EDKA triggers include infection/sepsis,51 52 exertion, physical stress, decreased caloric intake, cocaine intoxication,53 trauma, dehydration, persistent vomiting, insulin dose reduction/omission, anorexia, gastroparesis,54 insulin pump failure,32 acute pancreatitis,55 bariatric surgery,56–58 prolonged fasting, ketogenic diet, alcohol use disorder, glycogen storage disease, and chronic liver disease 11 59–61. Patients with low to normal body mass index on SGLT-2 inhibitor are particularly vulnerable to EDKA,25 as are patients with T1DM when using SGLT-2 inhibitors 25.…”

COVID-19, Pregnancy, and Diabetes Mellitus

“…The cause of low blood glucose levels is usually a poor general condition, e. g., associated with nausea and vomiting, and as a consequence of reduced or even no food intake. We found nine case reports in pregnant women related to COVID-19 (▶ Table 2) [37][38][39][40][41][42][43][44].…”

Euglycemic diabetic ketoacidosis and COVID‐19 management in a term pregnant patient; a case report

“…COVID‐19 may accelerate ketosis and ketoacidosis without diabetes mellitus with ketosis separately associated with increased hospital stays and mortality in younger patients 5 . DKA is more likely developed in pregnant woman compared to non‐pregnant women with diabetes (8.9% vs. 3.1%, respectively) 6 …”