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Dka And Fetal Demise

Diabetic Ketoacidosis Among Pregnant And Non-pregnant Women: A Comparison Of Morbidity And Mortality

Diabetic Ketoacidosis Among Pregnant And Non-pregnant Women: A Comparison Of Morbidity And Mortality

Get access/doi/full/10.1080/14767058.2018.1443071?needAccess=true Purpose: Diabetic ketoacidosis (DKA) is a critical diagnosis that can cause severe morbidity and mortality in the diabetic population. Although it is rare in pregnancy, the aim of this study is to compare DKA in pregnant women with age-matched non-pregnant women to determine if outcomes are influenced by pregnancy. Materials and methods: A population-based age-matched retrospective cohort was carried out using data from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample from 1999 to 2013. Pregnant patients with DKA were age-matched with non-pregnant controls also admitted with DKA at a ratio of 1:10. Severe morbidities and mortality were compared among the two groups. Logistic regression was used to adjust for baseline characteristics and comorbidities. Results: We identified 4661 cases of DKA in pregnancy during our study period, which were age-matched to 46,610 non-pregnant controls. Pregnant women with DKA were more likely to stay in hospital for >3 d (odds ratios (OR) 2.15, 95% CI 2.062.25) and had more associated renal failure (OR 2.86, 95% CI 1.764.55); however, they were less likely to require ventilation (OR 0.70, 95% CI 0.620.79), experience systemic inflammatory response syndrome (OR 0.53, 95% CI 0.380.73), or seizures (OR 0.49, 95% CI 0.420.57). Among pregnant women, rates of coma (0.04%) and death (0.17%, OR 0.23, 95% CI 0.140.39) were lower than previously reported and lower than non-pregnant women. Conclusion: Pregnant women with DKA are admitted to hospital for longer periods than non-pregnant controls and are at higher risk for renal failure but otherwise have better outcomes and less mortality than non-pregnant controls. Continue reading >>

Diabetes And Pregnancy

Diabetes And Pregnancy

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, orproperly 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 hormones to maintain the 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 >>

Diabetic Ketoacidosis In Pregnancy

Diabetic Ketoacidosis In Pregnancy

The occurrence of diabetic ketoacidosis in pregnancy compromises both the fetus and the mother. It usually occurs in the later stages of pregnancy and is also seen in newly presenting type 1 diabetes patients. Despite improvement in its incidence rates and outcomes over the years, it still remains a major clinical problem since it tends to occur at lower blood glucose levels and more rapidly than in non-pregnant patients often causing delay in the diagnosis. This article illustrates a typical case of diabetic ketoacidosis in pregnancy and reviews the literature to provide an insight into its pathophysiology and management. Full Text Selected References These references are in PubMed. This may not be the complete list of references from this article. Continue reading >>

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 >>

Diabetic Ketoacidosis In Pregnancy

Diabetic Ketoacidosis In Pregnancy

Diabetic ketoacidosis is a serious metabolic complication of diabetes with high mortality if undetected. Its occurrence in pregnancy compromises both the fetus and the mother profoundly. Although predictably more common in patients with type 1 diabetes, it has been recognised in those with type 2 diabetes as well as gestational diabetes, especially with the use of corticosteroids for fetal lung maturity and β2-agonists for tocolysis.1–3 Diabetic ketoacidosis usually occurs in the second and third trimesters because of increased insulin resistance, and is also seen in newly presenting type 1 diabetes patients. With increasing practice of antepartum diabetes screening and the availability of early and frequent prenatal care/surveillance, the incidence and outcomes of diabetic ketoacidosis in pregnancy have vastly improved. However, it still remains a major clinical problem in pregnancy since it tends to occur at lower blood glucose levels and more rapidly than in non-pregnant patients often causing delay in the diagnosis. The purpose of this article is to illustrate a typical patient who may present with diabetic ketoacidosis in pregnancy and review the literature on this relatively uncommon condition and provide an insight into the pathophysiology and management. MAGNITUDE OF THE PROBLEM In non-pregnant patients with type 1 diabetes, the incidence of diabetic ketoacidosis is about 1–5 episodes per 100 per year with mortality averaging 5%–10%.4 The incidence rates of diabetic ketoacidosis in pregnancy and the corresponding fetal mortality rates from different retrospective studies5–8 are summarised in the table 1. As is evident from the table, both the incidence and rates of fetal loss in pregnancies have fallen in recent times compared with those before. In 1963 Continue reading >>

Adverse Fetal Outcomes Tied To Maternal Dka, Study Finds

Adverse Fetal Outcomes Tied To Maternal Dka, Study Finds

A study in Diabetes Care found that fetal demise occurred in 15.6% of cases among 62 women who had at least one diabetic ketoacidosis event during pregnancy. Higher pre-DKA A1C levels and smoking were associated with an increased risk of preterm birth, while higher NICU admission rates correlated with higher anion gap during DKA event, preterm birth, preeclampsia and smoking. Continue reading >>

A Case Of Ketoacidosis In Pregnancy

A Case Of Ketoacidosis In Pregnancy

Abstract: Background: Pregnant women are predisposed to accelerated starvation due to continuous nutrient demands by the fetus, and they have increased susceptibility to ketogenesis during periods of caloric deprivation [1, 2]. We report a case of starvation ketoacidosis in a patient with gestational diabetes on a carbohydrate-restricted diet. Clinical case: A 30 year-old woman, gravida 5, para 2, with a history of spina bifida and hydrocephalus status post ventriculoperitoneal shunt, presented at 37 weeks of gestation with dyspnea. Her pregnancy had been complicated by gestational diabetes mellitus treated with a carbohydrate-restricted diet of 30 g a day. Due to a previous pregnancy complicated by late intrauterine fetal demise, a caesarean section was planned at 37 weeks of gestation after administration of steroids to induce fetal lung maturity. On admission, the patient’s blood pressure was 116/69 mm Hg, heart rate 106 beats per minute, oral temperature 36 °C, pulse ox 97%, and respiratory rate 20 breaths per minute. Laboratory tests showed a mixed metabolic acidosis and respiratory alkalosis with pH 7.3 (7.33 - 7.43), HCO3 7.3 meq/l (20 - 27 meq/l), positive urinary ketones, and glucose of 75 mg/dl (65 – 139 mg/dl). Her glycosylated hemoglobin was 5.8% (4.0 - 6.0 %), C-peptide level 14.3 ng/ml (0.6 - 12.0 ng/ml), total insulin level 4.1 uU/ml (5 to 25 uU/ml), and lactate 1.8 mmol/l (0.5 - 2.2 mmol/l). Her dyspnea progressed, requiring intubation followed by emergent caesarean section. Afterwards, she was transferred to the surgical intensive care unit. She was treated with intravenous fluids containing dextrose and bicarbonate; she never received insulin and her blood glucose ranged from 65 to 139 mg/dl. By hospital day 3, the metabolic acidosis resolved, and Continue reading >>

Diabetic Ketoacidosis In Pregnancy

Diabetic Ketoacidosis In Pregnancy

Diabetic ketoacidosis affects only 1% to 3% of pregnancies complicated by diabetes; nonetheless it is an acute medical emergency with a potential for dire consequences for both mother and fetus.9,19,31 The maternal mortality rate secondary to diabetes has fallen remarkably from a preinsulin era high of 50% to less than 1% today.18 The rate of maternal loss owing to diabetic ketoacidosis in pregnancy is unknown but most likely ranges from 4% to 15%.18,24,46 The majority of reports on ketoacidosis in pregnancy contain data on 20 or fewer patients, thus maternal mortality rates once ketoacidosis ensues must be extrapolated from nonpregnant data. In the series reported by Gabbe and co-workers,18 7 of 24 deaths in pregnant diabetic women resulted from metabolic complications, with 4 caused by ketoacidosis. Clements and Vourganti11 and Hollingsworth28 have suggested that many of these deaths could have been prevented by appropriate management. Diabetic ketoacidosis more commonly occurs in the second and third trimesters when increased insulin resistance is present.18,41 Fetal mortality has also decreased markedly since the introduction of insulin; however, it is still excessively high. Historically, fetal loss rates have ranged from 30% to 90%.16,32,33 Recently, Montoro and co-workers39 studied 20 type I diabetic pregnant women with ketoacidosis. On admission, seven women (35%) were diagnosed with a fetal demise. None of the remaining 13 women sustained fetal loss once therapy was begun. Kilvert and colleagues31 reported a fetal loss rate of 22% (including spontaneous abortions), with only one (14%) loss among seven cases occurring after the first trimester. Kent and co-workers30 compared fetal mortality among 21 pregnant women with brittle diabetes (those with recurrent keto Continue reading >>

Diabetic Ketoacidosis Poses Fetal Risk During/after Event

Diabetic Ketoacidosis Poses Fetal Risk During/after Event

WEDNESDAY, June 21, 2017 (HealthDay News) -- 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. Abstract/Full Text (subscription or payment may be required) This article: Copyright © 2017 HealthDay. All rights reserved. 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 >>

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 Mellitus And Pregnancy

Diabetes Mellitus And Pregnancy

Practice Essentials Gestational diabetes mellitus (GDM) is defined as glucose intolerance of variable degree with onset or first recognition during pregnancy. A study by Stuebe et al found this condition to be associated with persistent metabolic dysfunction in women at 3 years after delivery, separate from other clinical risk factors. [1] Infants of mothers with preexisting diabetes mellitus experience double the risk of serious injury at birth, triple the likelihood of cesarean delivery, and quadruple the incidence of newborn intensive care unit (NICU) admission. Gestational diabetes mellitus accounts for 90% of cases of diabetes mellitus in pregnancy, while preexisting type 2 diabetes accounts for 8% of such cases. Screening for diabetes mellitus during pregnancy Gestational diabetes The following 2-step screening system for gestational diabetes is currently recommended in the United States: Alternatively, for high-risk women or in areas in which the prevalence of insulin resistance is 5% or higher (eg, the southwestern and southeastern United States), a 1-step approach can be used by proceeding directly to the 100-g, 3-hour OGTT. The US Preventive Services Task Force (USPSTF) recommends screening for gestational diabetes mellitus after 24 weeks of pregnancy. The recommendation applies to asymptomatic women with no previous diagnosis of type 1 or type 2 diabetes mellitus. [2, 3] The recommendation does not specify whether the 1-step or 2-step screening approach would be preferable. Type 1 diabetes The disease is typically diagnosed during an episode of hyperglycemia, ketosis, and dehydration It is most commonly diagnosed in childhood or adolescence; the disease is rarely diagnosed during pregnancy Patients diagnosed during pregnancy most often present with unexpected Continue reading >>

Diabetic Ketoacidosis In Pregnancy: A Case Report

Diabetic Ketoacidosis In Pregnancy: A Case Report

1. Professor and HOD, Department of Obstetrics and Gynaecology, BLDE University s Shri B.M. Patil Medical College. 2. Post Graduate, Department of Obstetrics and Gynaecology, BLDE University s Shri B.M. Patil Medical College. CORRESPONDING AUTHOR: Dr. J. Aishwarya, Post Graduate, Department of Obstetrics and Gynaecology, BLDE University’s, Shri B.M. Patil Medical College, Bijapur, Karnataka. Email: [email protected] ABSTRACT: Diabetic ketoacidosis is a serious metabolic complication and its occurrence in pregnancy compromises the life of fetus and mother profoundly. Here by a case of G4P3L3 with term gestation with intrauterine death with diabetic ketoacidosis in labor is reported and the management done for the successful outcome of mother is discussed. Prevention, early recognition, hospitalization and management remain the cornerstones to minimize the outcomes of this dreaded condition. KEYWORDS: Diabetic ketoacidosis (DKA), intrauterine death, diabetes. How to cite this article Purushotaman Jaju, J. Aishwarya. Diabetic Ketoacidosis in Pregnancy: A Case Report. Journal of Evolution of Medical and Dental Sciences 2014; Vol. 3, Issue 39, August 28; Page: 9964-9967, DOI: 10.14260/jemds/2014/3292 INTRODUCTION: Diabetic ketoacidosis is an infrequent and is a serious metabolic complication of diabetes with high mortality if undetected. Its occurrence in pregnancy compromises both the fetus and the mother profoundly. Although predictably more common in patients with type 1 diabetes,1-3 it has been recognized in those with type 2 diabetes as well as gestational diabetes. It usually occurs in later stages of pregnancy. We report a case of diabetic ketoacidosis who is a known case of type 2 diabetic mellitus and Presented with intrauterine fetal demise. CASE REPORT: A 33 yr Continue reading >>

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