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Euglycemic DKA in Pregnancy: Case Report
Abstract Number: F-25
Abstract Type: Case Report/Case Series
Euglycemic DKA in Pregnancy: A Case Report
Physiologic changes associated with pregnancy can alter the presentation of diabetic ketoacidosis (DKA) from the classic triad of hyperglycemia, anion gap metabolic acidosis and ketonemia. DKA in pregnancy is a relatively rare complication with an incidence between 1-3%, but represents an emergency for both the mother and fetus as perinatal mortality rates have been reported to be as high as 30%. (1-4)
This poster contains a review of relevant physiologic changes associated with pregnancy that increase a patient’s susceptibility to the development of DKA and a case report of a parturient whose diagnosis of DKA was delayed secondary to absence of hyperglycemia.
A 27yo G6 P0141 at 35+3/7 weeks gestational age with a past medical history significant for insulin-dependent diabetes mellitus was transferred from an outside hospital due to concerns for premature labor. Upon admission, the patient was found to have abdominal pain, nausea and vomiting with no signs of labor. Labs upon admission were notable for a bicarbonate of 9, an anion gap of 21, glucose of 105 and urine ketones of 150mg/dL. It was not initially recognized that the patient was in DKA as her glucose was normal and she did not appear toxic. Over the course of the day, the patient became increasingly tachypneic with worsening nausea, vomiting and persistent abdominal pain. An arterial blood gas was obtained at this time and was notable for a pH of 7.25, an anion gap of 27 and a pCO2 of 12. She was also found to have a beta hydroxybutyrate >8. The decision was made to proceed with delivery via cesarean section shortly after the patient was transferred to the intensive care unit. Following delivery, treatment with fluids and insulin was continued in the ICU and the patient was successfully extubated on postoperative day one. No infectious etiology was ever identified as the inciting event for DKA. The baby was admitted to the NICU for a brief period where he was treated for hypoglycemia and monitored for sepsis, which he never developed.
Physiologic changes during pregnancy can alter the presentation of DKA in the peripartum period, possibly delaying the initial diagnosis. DKA is a relatively rare complication in pregnancy, but can be responsible for high maternal and fetal mortality if not recognized and treated in a timely manner.
1. Carroll M, Yeomans E. Diabetic ketoacidosis in pregnancy. Critical Care Medicine 2005: 33 S347-S353.
2. ACOG Practice Bulletin No. 60 Pregestational Diabetes Mellitus. Obstet Gynecol 2005; 105: 675-685
3. Chauhan SP, Perry KG, McLaughlin BN et al. Diabetic keotacidosis complicating pregnancy. J Perinatol 1996; 16: 173-175
4. Cullen MT, The changing presentations of diabetic ketoacidosis during pregnancy. Am J Perinatol 1996; 13:449-451