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Dka And Fetal Demise

Diabetic Ketoacidosis In Pregnancy

Diabetic Ketoacidosis In Pregnancy

Abstract Diabetic ketoacidosis (DKA) is a life-threatening medical emergency and is characterized by hyperglycemia, acidosis, and ketonemia. DKA is observed in 5–10 % of all pregnancies complicated by pregestational diabetes mellitus. Laboratory findings are as follows: Ketonemia 3 mmol/L and over or significant ketonuria (more than 2+ on standard urine sticks) Blood glucose over 11 mmol/L or known diabetes mellitus Bicarbonate (HCO3 −−) below 15 mmol/L and/or venous pH less than 7.3 Common risk factors for DKA in pregnancy are new-onset diabetes, infections like UTI, influenza, poor patient compliance, insulin pump failure, treatment with β-mimetic tocolytic medications, and antenatal corticosteroids for fetal lung maturity. Patient should be counseled about the precipitating cause and early warning symptoms of DKA. DKA should be treated promptly, and HDU/level 2 facility with trained nursing staff and/or insertion of central line is required during pregnancy for its management. Continuous fetal heart rate monitoring commonly demonstrates recurrent late decelerations. Delivery is rarely indicated as FHR pattern resolves as maternal condition improves. DKA therapy can lead to frequent complication of hypoglycemia and hypokalemia, so glucose and K concentration monitoring should be done judiciously. Maternal mortality is rare now with proper management, but fetal mortality is still quite high ranging from 10 to 35 %. Continue reading >>

Managing Severe Preeclampsia And Diabetic Ketoacidosis In Pregnancy

Managing Severe Preeclampsia And Diabetic Ketoacidosis In Pregnancy

US Pharm. 2010;35(9):HS-2-HS-8. Pregnancy is associated with increased levels of emotional and physical stress. Women with preexisting conditions such as hypertension and diabetes require intense prenatal monitoring by health care professionals. Pharmacists in direct contact with patients can play an integral role in identifying signs and symptoms that require immediate care. Two conditions that require emergent treatment in pregnant women are severe preeclampsia and diabetic ketoacidosis. SEVERE PREECLAMPSIA Hypertensive disorders can affect 6% to 8% of women and increase the risk of morbidity and mortality in both the expectant mother and the unborn child.1,2 Hypertension in pregnancy is divided into four categories: chronic hypertension, gestational hypertension, preeclampsia, and preeclampsia superimposed on chronic hypertension. The focus in this article is on severe preeclampsia, but a brief discussion of preeclampsia is warranted. Preeclampsia, a pregnancy-specific syndrome of unknown etiology, is a multiorgan disease process characterized by the development of hypertension and proteinuria after 20 weeks' gestation.1,2 See TABLE 1 for diagnostic criteria.1,2 History of antiphospholipid antibody syndrome, chronic hypertension, chronic renal disease, elevated body-mass index, age 40 years or older, multiple gestation, nulliparity, preeclampsia in a previous pregnancy, and pregestational diabetes mellitus increase a woman's risk of preeclampsia.1 Preeclampsia is classified as mild or severe based on the degree of hypertension, the level of proteinuria, and the presence of symptoms resulting from the involvement of the kidneys, brain, liver, and cardiovascular system. The incidence of severe preeclampsia is 0.9% in the United States.3 Severe preeclampsia is associate Continue reading >>

Management Of Pregnancy In Women With Type 1 Diabetes Mellitus: Guidelines Of The French-speaking Diabetes Society (société Francophone Du Diabète [sfd])

Management Of Pregnancy In Women With Type 1 Diabetes Mellitus: Guidelines Of The French-speaking Diabetes Society (société Francophone Du Diabète [sfd])

The clinical guidelines reported by the French-Speaking Diabetes Society (Société francophone du diabète) include updated recommendations for preconceptual planning and care in the management of pregnancy in women with type 1 diabetes mellitus (T1DM). The working group included diabetologists, as well as an obstetrician, a nurse and a dietician. A review of the literature was performed using PubMed and Cochrane databases. Guidelines published by foreign diabetes societies were also consulted. In women with T1DM, pregnancy increased the risks of hypoglycaemia, diabetic ketoacidosis, pregnancy-induced hypertension, infections and worsening of diabetic microvascular disease. Moreover, T1DM during pregnancy had an impact on the embryo and the fetus, and may have increased the risk of spontaneous miscarriages, malformations, premature births, and fetal and neonatal complications. However, intensive glycaemic control and preconceptual care have been shown to decrease the rate of fetal demise and malformations. Also, the use of insulin analogues during pregnancy is now regarded as safe. Tight glucose control and frequent follow-up are recommended throughout pregnancy in women with T1DM. Their obstetric management should take place in a maternity hospital with an appropriate perinatal environment and in close collaboration with diabetologists. Pregnancy planning and adequate management during pregnancy are mandatory for improving the outcomes of women with T1DM. The full text of this article is available in PDF format. Ce référentiel de la Société francophone du diabète a pour objet de préciser les modalités de la prise en charge préconceptionnelle et pendant la grossesse des femmes atteintes de diabète de type 1 (DT1). Le groupe de travail a été constitué de dia Continue reading >>

Diabetic Ketoacidosis Mimicking Hyperemesis Gravidarum: Case Report

Diabetic Ketoacidosis Mimicking Hyperemesis Gravidarum: Case Report

Diabetic ketoacidosis (DKA) characterized by hyperglycemia, ketosis and acidosis is a serious metabolic decompensation of diabetes mellitus (DM). It is a medical emergency that can occur in type 1, type 2 and gestational diabetes. Polyuria, polydipsia, nausea, vomiting, weakness, weight loss are the symptoms of DKA. Acidemia, hyperglycemia, increased anion gap, ketonemia, ketonuria are the laboratory findings. DKA can cause fetal and maternal mortality during pregnancy and usually occurs in the second and third trimester due to increased insulin resistance (1). Infections, emesis, non-compliance, insulin pump failure, drugs such as corticosteroids and β- sympathetomimetic agents, undiagnosed pregnancy are the precipitating factors. Maternal acidosis, hyperglycemia, volume depletion, electrolyte imbalance may effect the fetus. Aggressive fluid replacement, insulin infusion, as well as searching, correcting and treating the precipitating factors and electrolyte imbalance are the treatment modalities (1,2). Nausea and vomiting accompany 50-90% of all pregnancies (3). It is mostly self-limiting and peaks at 9 weeks of gestation. The most severe degree of vomiting during pregnancy is hyperemesis gravidarum (HG). It is characterized by persistent vomiting, weight loss, ketonuria, electrolyte abnormalities, and dehydration (4). Metabolic acidosis and ketonaemia may occur both in HG and DKA. Metabolic disorders such as DKA, gastrointestinal conditions, pyelonephritis, neurological causes and vestibular disorders should be considered in the differential diagnosis of HG (3,4). In this report, we describe a case of type 1 DM with fulminant course which occurred in the second trimester of pregnancy mimicking HG and resulted in fetal loss. Case Report A 30-year-old woman, nullipara Continue reading >>

Retrospective Analysis Of Diabetic Ketoacidosis In Pregnant Women Over A Period Of 3 Years

Retrospective Analysis Of Diabetic Ketoacidosis In Pregnant Women Over A Period Of 3 Years

1Department of Diabetes and Endocrine, Hamad Medical Corporation, Doha, Qatar 2Department of Obstetrics and Gynecology, Hamad Medical Corporation, Doha, Qatar 3Department of Obstetrics, Sidra Medical and Research Center, Doha, Qatar Corresponding Author: Khaled Ahmed Baagar Department of Diabetes and Endocrine Hamad Medical Corporation, P.O. Box 3050, Doha, Qatar Tel: +974-66049423 E-mail: [email protected] Citation: Baagar KA, Aboudi AK, Khaldi HM, Alowinati BI, Abou-Samra AB, et al. (2017) Retrospective Analysis of Diabetic Ketoacidosis in Pregnant Women over a Period of 3 Years . Endocrinol Metab Syndr 6:265. doi:10.4172/2161-1017.1000265 Copyright: © 2017 Baagar KA, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Visit for more related articles at Endocrinology & Metabolic Syndrome Abstract Objective: The incidence of diabetic ketoacidosis in pregnancy (DKP) varies from 0.5%, the lowest reported rate in western countries, to 8.9% in a study conducted in China. The associated fetal mortality is 9-36%. This study aimed to assess the current incidence, causes, and outcomes of diabetic ketoacidosis in pregnancy and identify factors associated with favorable outcomes. Methods: A retrospective chart review of 20 diabetic ketoacidosis hospital admissions of 19 pregnant women from 3,679 diabetic pregnancies delivered between June 2012 and May 2015 was conducted. Those with successful DKP management (group A) or with intrauterine fetal death or urgent delivery during diabetic ketoacidosis management (group B) were compared. Results: Thirteen cases had type 1 diabetes, and 6 cases had Continue reading >>

Chapter 11: Diabetic Ketoacidosis In Pregnancy

Chapter 11: Diabetic Ketoacidosis In Pregnancy

Despite recent advances in the evaluation and medical treatment of diabetes in pregnancy, diabetic ketoacidosis (DKA) remains a matter of significant concern. The fetal loss rate in most contemporary series has been estimated to range from 10% to 25%. Fortunately, since the advent and implementation of insulin therapy, the maternal mortality rate has declined to 1% or less. In order to favorably influence the outcome in these high-risk patients, it is imperative that the obstetrician/provider be familiar with the basics of the pathophysiology, diagnosis, and treatment of DKA in pregnancy. DKA is characterized by hyperglycemia and accelerated ketogenesis. Both a lack of insulin and an excess of glucagon and other counter-regulatory hormones significantly contribute to these problems and their resultant clinical manifestations. Glucose normally enters the cell secondary to the effects of insulin. The cell then may use glucose for nutrition and energy production. When insulin is lacking, glucose fails to enter the cell. The cell responds to this starvation by facilitating the release of counter-regulatory hormones, including glucagon, catecholamines, and cortisol. These counter-regulatory hormones are responsible for providing the cell with an alternative substrate for nutrition and energy production. By the process of gluconeogenesis, fatty acids from adipose tissue are broken down by hepatocytes to ketones (acetone, acetoacetate, and β-hydroxybutyrate [BHB] = ketone bodies), which are then used by the body cells for nutrition and energy production (Fig. 11-1). The lack of insulin also contributes to increased lipolysis and decreased reutilization of free fatty acids, thereby providing more substrate for hepatic ketogenesis. A basic review of the biochemistry involving D Continue reading >>

Pregnancy Complicated By Diabetic Ketoacidosis

Pregnancy Complicated By Diabetic Ketoacidosis

Maternal and fetal outcomes Despite intensified insulin treatment and strict surveillance of metabolic control in diabetic women during pregnancy, diabetic ketoacidosis (DKA) complicates 2–9% of diabetic pregnancies (1) and represents the leading cause of fetal loss, with a fetal mortality rate of 30–90% (1–3). From August 1991 to December 2001, 2,025 pregnant women with diabetes were admitted to the University of Tennessee Women’s Hospital. Of these, 888 women (44%) received insulin therapy, and 11 women (1.2%) presented with DKA (blood glucose: 377 ± 27 mg/dl, pH: 7.22 ± 0.01, bicarbonate 7.9 ± 3 mEq/l, and positive serum ketones). White’s diabetic classification included class A2, four patients (27%); class B, five patients (45%); class C, one patient (9%); and class D, one patient (9%). The four women with gestational diabetes mellitus (GDM) were African-American, had a mean age of 25 ± 1 year, a BMI of 34 ± 3 kg/m2, and an estimated gestational age of 29 ± 1 weeks. Patients with a previous history of diabetes had a mean duration of diabetes of 6 ± 1 year, a mean age of 27 ± 1 year, a BMI of 30 ± 2 kg/m2, and a gestational age of 28 ± 1 weeks. Infection (27%) and a history of the omission of insulin therapy (18%) were the most common precipitating causes. There were no maternal deaths, and the mean maternal length of hospital stay was 7 ± 2 days. Two patients presented with intrauterine fetal demise, and there was one additional fetal death giving an overall fetal death rate of 27%. During labor, four patients had nonreassuring fetal heart rate tracings in the form of late decelerations that resolved with correction of DKA. At birth, the mean (5 min) Apgar was 8.7 ± 0.4, and fetal weight was 1,278 ± 202 g. Four obese women with DKA had newly d Continue reading >>

Diabetic Ketoacidosis (dka)

Diabetic Ketoacidosis (dka)

Tweet Diabetic ketoacidosis (DKA) is a dangerous complication faced by people with diabetes which happens when the body starts running out of insulin. DKA is most commonly associated with type 1 diabetes, however, people with type 2 diabetes that produce very little of their own insulin may also be affected. Ketoacidosis is a serious short term complication which can result in coma or even death if it is not treated quickly. Read about Diabetes and Ketones What is diabetic ketoacidosis? DKA occurs when the body has insufficient insulin to allow enough glucose to enter cells, and so the body switches to burning fatty acids and producing acidic ketone bodies. A high level of ketone bodies in the blood can cause particularly severe illness. Symptoms of DKA Diabetic ketoacidosis may itself be the symptom of undiagnosed type 1 diabetes. Typical symptoms of diabetic ketoacidosis include: Vomiting Dehydration An unusual smell on the breath –sometimes compared to the smell of pear drops Deep laboured breathing (called kussmaul breathing) or hyperventilation Rapid heartbeat Confusion and disorientation Symptoms of diabetic ketoacidosis usually evolve over a 24 hour period if blood glucose levels become and remain too high (hyperglycemia). Causes and risk factors for diabetic ketoacidosis As noted above, DKA is caused by the body having too little insulin to allow cells to take in glucose for energy. This may happen for a number of reasons including: Having blood glucose levels consistently over 15 mmol/l Missing insulin injections If a fault has developed in your insulin pen or insulin pump As a result of illness or infections High or prolonged levels of stress Excessive alcohol consumption DKA may also occur prior to a diagnosis of type 1 diabetes. Ketoacidosis can occasional Continue reading >>

Fetal Effects Of Diabetic Ketoacidosis

Fetal Effects Of Diabetic Ketoacidosis

The greatest hazard facing the pregnant diabetic patient with DKA is fetal loss. The exact fetal loss rate is difficult to assess because of the small reported series in the literature. Historically, the reported fetal mortality ranged between 30 and 90%7 but remarkable progress has been made both in fetal assessment techniques and in the treatment of DKA, and mortality rates in more recent reviews are 10%.20 Needless to say, fetal loss is primarily related to the severity of the maternal illness and the degree of metabolic decompensation. Most fetal losses occur prior to diagnosis and therefore to the onset of efficient treatment. As ketone bodies freely cross the placenta, maternal acidosis is assumed to cause fetal acidosis; however, the exact mechanism by which maternal DKA affects the fetus remains unclear. Suggestions include a decrease in uterine blood flow and fetal hypoxemia, maternal hyperke-tonemia inducing fetal hypoxemia, and fetal hyperglycemia causing an increased fetal oxidative mechanism and a decreased fetal myocardial contractility. Indeed, fetal potassium deficit has been found to lead to fetal cardiac arrest.7 Fetal hypoxia may also be attributed to a DKA-associated phosphate deficit which leads to depletion of red cell 2,3-diphosphoglycerate and consequent impairment of oxygen delivery. The risk of fetal distress, and even death, during the maternal DKA state makes it mandatory to continuously monitor the fetal heart and to assess the biophysical score, and to evaluate the fetal acid-base balance by cordocentesis if necessary. In the few case reports of fetal monitoring during maternal DKA, a nonreassuring pattern with tachycardia, reduced variability and late decelerations was reported.21,22 LoBue and Goodlin23 found that the administration of jus Continue reading >>

Diabetes And Pregnancy

Diabetes And Pregnancy

What is diabetes? Diabetes is a condition in which the body can't produce enough insulin, or it can't use it properly. Insulin is the hormone that allows glucose (sugar) to enter the cells to be used as fuel. When glucose cannot enter the cells, it builds up in the blood. This is called hyperglycemia or high blood sugar. Damage from diabetes comes from the effects of hyperglycemia on other organ systems including the eyes, kidneys, heart, blood vessels, and nerves. In early pregnancy, hyperglycemia can result in birth defects. What are the different types of diabetes? There are three basic types of diabetes including: Type 1 diabetes. Also called insulin-dependent diabetes mellitus (IDDM), type 1 diabetes is an autoimmune disorder in which the body's immune system destroys, or attempts to destroy, the cells in the pancreas that produce insulin. Type 1 diabetes usually develops in children or young adults, but can start at any age. Type 2 diabetes. A metabolic disorder resulting from the body's inability to make enough, or properly use, insulin. It used to be called noninsulin-dependent diabetes mellitus (NIDDM). Gestational diabetes. A condition in which the blood glucose level is elevated and other diabetic symptoms appear during pregnancy in a woman who has not previously been diagnosed with diabetes. Diabetes is a serious disease, which, if not controlled, can be life-threatening. It is often associated with long-term complications that can affect every system and part of the body. Diabetes can contribute to eye disorders and blindness, heart disease, stroke, kidney failure, amputation, and nerve damage. What happens with diabetes and pregnancy? During pregnancy, the placenta supplies a growing fetus with nutrients and water. The placenta also makes a variety of horm Continue reading >>

Diabetes In Pregnancy

Diabetes In Pregnancy

Patient professional reference Professional Reference articles are written by UK doctors and are based on research evidence, UK and European Guidelines. They are designed for health professionals to use. You may find the Type 2 Diabetes article more useful, or one of our other health articles. This article deals with pregnancy in patients with pre-existing diabetes. See also separate Gestational Diabetes article. Epidemiology Diabetes is the most common pre-existing medical disorder complicating pregnancy in the UK. Up to 5% of women giving birth in England and Wales have either pre-existing diabetes or gestational diabetes[1]. The number of people with type 1 diabetes and the prevalence of type 2 diabetes amongst women of child-bearing age are increasing. Pregnancies of women with diabetes are regarded as high-risk for both the woman and the baby[2]. Of women who have diabetes during pregnancy, it is estimated that approximately 87.5% have gestational diabetes, 7.5% have type 1 diabetes and the remaining 5% have type 2 diabetes[1]. Possible complications Diabetes in pregnancy is associated with risks to the woman and to the developing fetus[1]. Miscarriage, pre-eclampsia and preterm labour are more common in women with pre-existing diabetes. Diabetic retinopathy can worsen rapidly during pregnancy. Stillbirth, congenital malformations, macrosomia, birth injury, perinatal mortality and postnatal adaptation problems (eg, hypoglycaemia) are more common in babies born to women with pre-existing diabetes. Pre-conception care and good glucose control before and during pregnancy can reduce these risks. Increased risk of complications of diabetes Ketoacidosis may occur during the pregnancy. Progression of microvascular complications including retinopathy and nephropathy: poor Continue reading >>

Normoglycemic Diabetic Ketoacidosis In Pregnancy

Normoglycemic Diabetic Ketoacidosis In Pregnancy

The clinical presentation of diabetic ketoacidosis in pregnancy is usually the same as in nonpregnant women, although the blood glucose may not be as high as in the nongravid state. We report a case of a pregnant woman who developed diabetic ketoacidosis with a normal blood glucose and review the pertinent medical literature. A 29-year-old woman with type I diabetes developed diabetic ketoacidosis during induction of labor. She had a glucose level of 87 mg per 100 ml with ketonuria, a metabolic acidosis, and an anion gap of 20 mmol l−1. Normoglycemic diabetic ketoacidosis during pregnancy is truly unusual but can occur with relatively low, or even normal, blood sugars and necessitates prompt recognition and treatment. In this case, the combination of an initial episode of hypoglycemia and subsequent blood glucose levels below 95 mg per 100 ml led to a prolonged delay in the initiation of a planned insulin infusion for insulin coverage during the induction of labor. A significant ketoacidosis consequently developed, despite the absence of even a single elevated blood glucose measurement. This case illustrated the importance of not withholding insulin in a patient with type I diabetes for more than a few hours even if the blood glucose is normal. Normal pregnancy is characterized by a state of decreased insulin sensitivity, as well as accelerated lipolysis and ketogenesis.1, 2, 3, 4 The concentration of serum ketones has been estimated to be two to four times greater than in the nonpregnant state.1, 5 In addition, pregnant women have a respiratory alkalosis, lowering the serum bicarbonate concentration, thus reducing the capacity to buffer hydrogen ions. Despite these changes, the incidence of diabetic ketoacidosis (DKA) in pregnant diabetic women is only 1 to 3%.6, 7 K Continue reading >>

Diabetic Ketoacidosis Poses Fetal Risk During / After Event

Diabetic Ketoacidosis Poses Fetal Risk During / After Event

(HealthDay)—Diabetic ketoacidosis (DKA) during pregnancy poses risk for the fetus during and after the event, according to research published online June 12 in Diabetes Care. Fritha J.R. Morrison, M.P.H., from Tulane University in New Orleans, and colleagues conducted a retrospective cohort study involving pregnancies between 1996 and 2015 with at least one DKA event in women with type 1 diabetes. Data were included for 77 DKA events in 64 pregnancies among 62 women. The researchers found that fetal demise, preterm birth, and neonatal intensive care unit (NICU) admissions occurred in 15.6, 46.3, and 59 percent of pregnancies, respectively. In 60 and 40 percent of the cases, fetal demise occurred at the time of or within one week of DKA and between one and 11 weeks after DKA, respectively. The risk of fetal demise was significantly increased with maternal ICU admission and higher serum osmolality during the DKA event. Maternal smoking and higher pre-DKA hemoglobin A1c levels correlated with increased risk of preterm birth. Higher risk of NICU admission was seen with maternal smoking, preeclampsia during pregnancy, higher anion gap during DKA event, and preterm birth. "Further research is needed to identify effective methods for prevention, early recognition, and timely treatment of DKA in pregnancy to mitigate risk of fetal demise and other adverse fetal outcomes," the authors write. More information: Abstract/Full Text (subscription or payment may be required) Continue reading >>

Diabetes And Pregnancy

Diabetes And Pregnancy

What is diabetes? Diabetes is a condition in which the body can't produce enough insulin, or it can't use it properly. Insulin is the hormone that allows glucose (sugar) to enter the cells to be used as fuel. When glucose cannot enter the cells, it builds up in the blood. This is called hyperglycemia or high blood sugar. Damage from diabetes comes from the effects of hyperglycemia on other organ systems including the eyes, kidneys, heart, blood vessels, and nerves. In early pregnancy, hyperglycemia can result in birth defects. What are the different types of diabetes? There are three basic types of diabetes including: Type 1 diabetes. Also called insulin-dependent diabetes mellitus (IDDM), type 1 diabetes is an autoimmune disorder in which the body's immune system destroys, or attempts to destroy, the cells in the pancreas that produce insulin. Type 1 diabetes usually develops in children or young adults, but can start at any age. Type 2 diabetes. A metabolic disorder resulting from the body's inability to make enough, or properly use, insulin. It used to be called noninsulin-dependent diabetes mellitus (NIDDM). Gestational diabetes. A condition in which the blood glucose level is elevated and other diabetic symptoms appear during pregnancy in a woman who has not previously been diagnosed with diabetes. Diabetes is a serious disease, which, if not controlled, can be life-threatening. It is often associated with long-term complications that can affect every system and part of the body. Diabetes can contribute to eye disorders and blindness, heart disease, stroke, kidney failure, amputation, and nerve damage. What happens with diabetes and pregnancy? During pregnancy, the placenta supplies a growing fetus with nutrients and water. The placenta also makes a variety of horm Continue reading >>

Diabetes Ketoacidosis In Pregnancy

Diabetes Ketoacidosis In Pregnancy

Abstract Diabetic ketoacidosis (DKA) is a serious medical and obstetrical emergency usually occurring in patients with type 1 (insulin-dependent) diabetes mellitus. Although modern management of the patient with diabetes should prevent the occurrence of DKA during pregnancy, this complication still occurs and can result in significant morbidity and mortality for mother and/or fetus. Metabolic changes occurring during pregnancy can predispose a pregnant diabetic to DKA. The diagnosis of DKA can be more challenging during pregnancy as it does not always manifest with the classic presenting symptoms or laboratory findings. In fact, although uncommon, during pregnancy, DKA may develop even in the setting of relative normoglycemia. Prompt diagnosis and management is essential in order to optimize maternal and fetal outcomes. This article will provide the reader with information regarding the pathophysiology underlying DKA complicating pregnancy and will provide practical management guidelines for the diagnosis and management of this condition. Continue reading >>

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