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Euglycemic Dka Pregnancy

Euglycemic Diabetic Ketoacidosis In Pregnancy

Euglycemic Diabetic Ketoacidosis In Pregnancy

Diabetic ketoacidosis (DKA) can be a catastrophic event during pregnancy, complicating almost nine percent of diabetics in pregnancy. It induces both maternal and fetal mortality. Ketosis has been implicated in fetal distress and causes adverse neurological outcome. DKA with a relatively low blood sugar levels is called euglycemic DKA, which is a rare entity and reported usually in type I diabetic patients. A 37-year-old Saudi female patient known to have type II diabetes developed euglycemic [blood glucose level 4.3 mmol/L (78 mg/dl)] DKA while in her fifth pregnancy. She responded to intravenous dextrose and insulin with gradual improvement. Euglycemic DKA should be considered in type II diabetics during pregnancy and treated promptly. Do you want to read the rest of this article? ... Despite advances in diabetes management, the incidence is expected to increase because of the growing incidence of type 2 diabetes and GDM as a result of changes in pregnant women's demographics and the rising rate of pregnancies in women 35 years old or older [5]. Compared with DKA in non-pregnant patients, DKP is unique in a number of different aspects; it usually happens at lower (or even normal) blood glucose levels and progresses rapidly, requiring prompt diagnosis and management. Deleterious morbidities and mortality may affect both the woman and fetus. ... 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

Received Date: April 10, 2017; Accepted Date: May 03, 2017; Published Date: May 10, 2017 Citation: Baagar KA, Aboudi AK, Khaldi HM, Alowinati BI, Abou-Samra AB, et al. (2017) Retrospective Analysis of Diabetic Ketoacidosis inPregnant 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. 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 type 2 diabetes, including 2 new diagnoses. The most common precipitating factors were vomiting (55%) and insulin non-compliance (45%). Plasma glucose was <200 mg/dl in 50% of the patients. There was no maternal mortality, but there was one fetal death (5%). Only mean gestational age (21.8 11.0 versus 33.7 4.6 weeks, P=0.005) was significantly different between groups A (14 admissions) and B (6 adm Continue reading >>

Tangents: Endocrine Morning Report - Euglycemic Dka In Pregnancy

Tangents: Endocrine Morning Report - Euglycemic Dka In Pregnancy

Endocrine Morning Report - Euglycemic DKA in pregnancy A devastating complication of pregnancy in type I diabetics A special thank you to Dr. Robert Silver for leading our discussion of the case. Today we discussed an interesting case of a 29 year old G1P0 female who presented at 32 weeks gestation with a chief complaint of shortness of breath. On her third day of admission in hospital, she developed worsening of her symptoms and her respiratory rate increased to 40 breaths per minute, with a normal oxygen saturation (98%) on room air. Her capillary blood glucose registered a blood sugar of 10 mmol/L, and it was only after examining her arterial blood gas that a diagnosis of diabetic ketoacidosis (DKA) could be established. Her arterial blood gas (ABG) showed a pH of 7.29 / pCO2 of 14 / pO2 of 120 / HCO3 of 6. Her serum electrolytes showed an anion gap of 31, and alarmingly a serum potassium of 4.7 (in the context of insulin deficiency, this is worrisome). The appropriate intervention, being transfer to the intensive care unit, potassium replacement via a central line, and aggressive fluid resuscitationwere all initiated. She was started on an insulin infusion as well as IV D10W to maintain her blood sugar, and within 24 hours she was completely stable and back to her normal state of health. Table 1: The American Diabetes Association diagnostic criteria for DKA: triad of hyperglycemia, anion gap metabolic acidosis, and ketonemia. Why do pregnant patient's decompensate into DKA at a lower glucose? There are a number of cases reported in the literature of euglycemic DKA in pregnant patients, and it is thought to be a rare but devastating complication of pregnancy in type 1 diabetics. The frequency of occurrence is approximately 1% of all DKA's in pregnant patients (Guo, Continue reading >>

Glossary D

Glossary D

* DKA may occur with relatively low blood sugar levels during pregnancy Precipitating Factors for Diabetic Ketoacidosis in Pregnancy [2] Protracted vomiting, starvation , use of -sympathomimetic agents for tocolysis, infection, new-onset diabetes ,poor control of blood sugars or poor compliance with treatment , insulin pump failure ,steroid use for fetal lung maturation or chronic medical disorder 1. Kitabchi AE, et al., Hyperglycemic crises in adult patients with diabetes. Diabetes Care. 2009 Jul;32(7):1335-43. doi: 10.2337/dc09-9032. PMID: 19564476 2. Diabetic ketoacidosis in pregnancy. Sibai BM, Viteri OA.Obstet Gynecol. 2014 Jan;123(1):167-78. doi: 10.1097/AOG.0000000000000060. PMID: 24463678 3. Guo RX, et. al., Diabetic ketoacidosis in pregnancy tends to occur at lower blood glucose levels: case-control study and a case report of euglycemic diabetic ketoacidosis in pregnancy. J Obstet Gynaecol Res. 2008 Jun;34(3):324-30. doi: 10.1111/j.1447-0756.2008.00720.x.PMID: 18588610 4. Chico M, et. al., Normoglycemic diabetic ketoacidosis in pregnancy. J Perinatol. 2008 Apr;28(4):310-2. doi: 10.1038/sj.jp.7211921. PMID: 18379571 5. Tarif N, Al Badr W. Euglycemic diabetic ketoacidosis in pregnancy. Saudi J Kidney Dis Transpl. 2007 Nov;18(4):590-3. PMID: 17951948 6. Himuro H, et al., A case of a woman with late-pregnancy-onset DKA who had normal glucose tolerance in the first trimester. Endocrinol Diabetes Metab Case Rep. 2014;2014:130085. doi: 10.1530/EDM-13-0085. Epub 2014 Apr 1. PMID: 24711923 7. Maislos M, et al., Diabetic ketoacidosis. A rare complication of gestational diabetes. Diabetes Care. 1992 Aug;15(8):968-70. PMID: 1505328 Continue reading >>

Afmr - Complicated Euglycemic Diabetic Ketoacidosis In Pregnancy

Afmr - Complicated Euglycemic Diabetic Ketoacidosis In Pregnancy

COMPLICATED EUGLYCEMIC DIABETIC KETOACIDOSIS IN PREGNANCY 1. Internal Medicine, The Wright Center for Graduate Medical Education, Scranton, PA, United States. Purpose of Study: There have been very few case reports of euglycemia and Diabetic ketoacidosis in pregnancy. The fetus and placenta can consume blood glucose preventing hyperglycemia even in the presence of DKA. Moreover, in pregnancy there is increased production of ketones. It is important that physicians recognize DKA with normoglycemia to start timely treatment. Delay in treatment can lead to severe maternal and fetal complications. Summary of Results: A 31 year old female with history of Type 1 Diabetes Mellitus who was 35 weeks pregnant came to the ER with chief complaints of nausea, vomiting and retrosternal burning sensation for 3 days. Symptoms started after she missed a few doses of her twice daily NPH insulin. Physical exam revealed mild epigastric tenderness. Vitals were stable except for mild tachycardia. Laboratory work showed: White count 7300/mm3, Sodium 135meq/L, Potassium 4.5meq/L, Chloride 100meq/L, Bicarbonate 10meq/L, BUN 8meq/L, Creatinine 0.8mg/dL, Blood glucose 97mg/dL. An ABG showed: pH 7.35, CO2 23mmHg. A diagnosis of high anion gap metabolic acidosis was made. Serum and urine ketones were found to be high. Blood and urine toxicology was negative. Even though glucose was normal, a provisional diagnosis of Diabetic ketoacidosis was made. Patient was started on D5NS with potassium drip intravenously. The blood glucose did not improve; symptoms worsened and follow up electrolyte panel in 2 hours showed further decrease in serum bicarbonate. Fluids were changed to D10 0.45%NS which minimally increased blood sugar to 120mg/dL. Patient received 4 units of intravenous insulin in 24 hours and a Continue reading >>

Euglycemic Dka Secondary To Sglt2 Inhibitors

Euglycemic Dka Secondary To Sglt2 Inhibitors

Authors: Priyanka Kailash (MS-4, Campbell University School of Osteopathic Medicine), Kevin Weaver, DO (Program Director, Lehigh Valley Health Network), and Krystle Shafer, MD (Attending Physician, York Hospital) // Edited by: Alex Koyfman, MD (@EMHighAK, EM Attending Physician, UT Southwestern Medical Center / Parkland Memorial Hospital) and Brit Long, MD (@long_brit) A 35-year-old male with a past medical history of type 2 diabetes arrives at the Emergency Department (ED) with altered mental status, nausea, vomiting, and diffuse abdominal pain that started 10 hours ago. The patient was recently started on an SGLT2 inhibitor. On examination, the patient is tachycardic (HR 126) and tachypneic (RR 25), with normal blood pressure (110/90). He is further noted to have dry mucous membranes and poor skin turgor. Blood glucose is noted to be 140 mg/dl, serum ketones 6.2 mmol/L, and arterial pH of 6.9. The patient is diagnosed with euglycemic DKA and quickly admitted to ICU for treatment. Pathogenesis of Typical DKA Two major complications from type 1 diabetes mellitus and type 2 diabetes mellitus are diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS). DKA is typically seen in younger individuals, while HHS is typically seen in older patients(1). In the pathogenesis of typical DKA, the body experiences a starved state. Insulin deficiency (either through decreased production or decrease sensitivity) leads to the inactivation of GLUT4 receptors on cells. GLUT4 receptors function to help transport glucose molecules into cells so that it can be converted into energy. Without GLUT4 receptor activation, the glucose entry into cells remains shut. Thus, the cells start to experience a starved state. To compensate, the body activates an alternative energy pathway †Continue reading >>

Dka That Wasn't: A Case Of Euglycemic Diabetic Ketoacidosis Due To Empagliflozin | Oxford Medical Case Reports | Oxford Academic

Dka That Wasn't: A Case Of Euglycemic Diabetic Ketoacidosis Due To Empagliflozin | Oxford Medical Case Reports | Oxford Academic

Sodium glucose co-transporter (SGLT-2) inhibitor is a relatively new medication used to treat diabetes. At present, the Food and Drug Administration (FDA) has only approved three medications (canagliflozin, dapagliflozin and empagliflozin) in this drug class for the management of Type 2 diabetes. In May 2015, the FDA issued a warning of ketoacidosis with use of this drug class. Risk factors for the development of ketoacidosis among patients who take SGLT-2 inhibitors include decrease carbohydrate intake/starvation, acute illness and decrease in insulin dose. When identified, immediate cessation of the medication and administration of glucose must be done, and in some instances, starting an insulin drip might be necessary. We present a case of a patient with diabetes mellitus being on empagliflozin (SGLT-2 antagonist) who was admitted for acute cholecystitis. The hospital course was complicated by euglycemic diabetic ketoacidosis after being kept nothing per orem before a contemplated cholecystectomy. The management of diabetes has evolved since its discovery in 1910. A gamut of medications has become available to address the glycemic control among diabetics especially for Type 2 diabetics. Empagliflozin is a sodium glucose co-transporter (SGLT-2) inhibitor that has been approved by the Food and Drug Administraiton (FDA) in August 2014. It has been the latest drug approved in the drug class since 2013. This case highlights a case of euglycemic ketoacidosis with the use of empagliflozin. A 61-year-old female presented to her primary care doctor with right upper quadrant abdominal pain for a day. Her onlymedical history is diabetes Type 2 maintained on empagliflozin and diet controlled hypertension. Patient used to be on the combination of metforminrepaglinide but has bee Continue reading >>

Diabetic Ketoacidosis In Pregnancy Tends To Occur At Lower Blood Glucose Levels: Case-control Study And A Case Report Of Euglycemic Diabetic Ketoacidosis Inpregnancy.

Diabetic Ketoacidosis In Pregnancy Tends To Occur At Lower Blood Glucose Levels: Case-control Study And A Case Report Of Euglycemic Diabetic Ketoacidosis Inpregnancy.

1. J Obstet Gynaecol Res. 2008 Jun;34(3):324-30. doi:10.1111/j.1447-0756.2008.00720.x. Diabetic ketoacidosis in pregnancy tends to occur at lower blood glucose levels: case-control study and a case report of euglycemic diabetic ketoacidosis inpregnancy. (1)Department of Obstetrics and Gynecology, the First Affiliated Hospital, Zheng Zhou University, Zheng Zhou, China. [email protected] BACKGROUND AND OBJECTIVE: The occurrence of diabetic ketoacidosis (DKA) duringpregnancy is considered a medical emergency. The aims of the present study wereto evaluate the incidence of DKA in pregnant and non-pregnant women withdiabetes; to compare the blood glucose levels at the diagnosis of DKA in pregnantand non-pregnant women; and to show a case of euglycemic DKA in pregnancy.METHODS: The subjects consisted of 90 cases of DKA in pregnant women withdiabetes and 286 cases of non-pregnant female inpatients receiving treatment for diabetes during 2001 to 2005 in our hospital. The incidence of DKA in pregnantand non-pregnant women with diabetes and the blood glucose levels at thediagnosis of DKA in pregnant and non-pregnant women were compared.RESULTS: DKA had a higher incidence in pregnant women with diabetes (8/90, 8.9%) than in non-pregnant women with diabetes (9/286, 3.1%) (P < 0.05). The bloodglucose levels (mmol/L) in pregnant women with DKA were significantly lower than those in non-pregnant women with DKA (16.3 +/- 4.6 vs 27.5 +/- 4.8, P < 0.001). Acase of euglycemic DKA in pregnancy was described whose serum glucose level wasonly 6.9 mmol/L.CONCLUSIONS: DKA in pregnant women with diabetes may occur more frequently, andat lower blood glucose levels than DKA in non-pregnant women with diabetes. 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 >>

Euglycemic Diabetic Ketoacidosis: A Review.

Euglycemic Diabetic Ketoacidosis: A Review.

Abstract INTRODUCTION: Diabetic ketoacidosis (DKA) is one of the most serious complications of diabetes. It is characterised by the triad of hyperglycemia (blood sugar >250 mg/dl), metabolic acidosis (arterial pH <7.3 and serum bicarbonate <18 mEq/L) and ketosis. Rarely these patients can present with blood glucose (BG) levels of less than 200 mg/dl, which is defined as euglycemic DKA. The possible etiology of euglycemic DKA includes the recent use of insulin, decreased caloric intake, heavy alcohol consumption, chronic liver disease and glycogen storage disorders. DKA in pregnancy has also been reported to present with euglycemia. The recent use of sodium glucose cotransporter 2 (SGLT2) inhibitors has shed light on another possible mechanism of euglycemic DKA. Clinicians may also be misled by the presence of pseudonormoglycemia. CONCLUSION: Euglycemic DKA thus poses a challenge to physicians, as patients presenting with normal BG levels in ketoacidosis may be overlooked, leading to a delay in appropriate management strategies. In this article, we review all the possible etiologies and the associated pathophysiology of patients presenting with euglycemic DKA. We also discuss the approach to diagnosis and management of such patients. Despite euglycemia, ketoacidosis in diabetic patients remains a medical emergency and must be treated in a quick and appropriate manner. Copyright© Bentham Science Publishers; For any queries, please email at [email protected] Continue reading >>

Bestbets: Euglycemic Diabetic Ketoacidosis: A Diagnostic Challenge

Bestbets: Euglycemic Diabetic Ketoacidosis: A Diagnostic Challenge

In [adults with diabetic ketoacidosis presenting to the emergency department], what is the [significance and etiology] of [euglycemia (serum blood glucose less than 200)]? A 28 year old patient with a past medical history of type II diabetes and irritable bowel syndrome currently taking a SGLT-2 inhibitor for his diabetes presents to the Emergency Department with the chief complaint of nausea and vomiting with associated fatigue. The patient is evaluated and treated for their nausea and vomiting. The patient continues to have intractable vomiting despite conventional therapy. On laboratory evaluation they are found to have a blood sugar of 162, pH of 7.2, elevated betahydroxybutyrate and large ketones in the urine. Medline 1966-08/17 using OVID interface, Cochrane Library (2017), and Embase [(exp Ketoacidosis) AND (exp euglycemia OR euglycaemia OR euglycemic)] 98 studies were identified; the majority of publications were single case reports or reviews. Two case series addressed the three part question Retrospective case series analysis of patients admitted to the diabetic ward with diabetic metabolic decompensation Patients presenting in DKA with blood glucose levels less than 300 211 total episodes of DKA - 37 episodes presented with blood sugars less than 300 Low number of total episodes analyzed; no comparison of sample patient groups (hyperglycemic > 300) vs euglycemic (<300) Peters AL, Buschur EO, Buse JB, Cohan P, Diner JC, Hirsch IB Patients with Type 1 or Type 2 Diabetes that are on SGLT-2 Inhibitors that presented to the hospital in DKA Case Series of patients presenting with euglycemic DKA (Blood Glucose < 300) that are on SGLT-2 Inhibitors Association between use of a SGLT-2 inhibitor and presentation to the hospital in euglycemic DKA 13 cases from across th Continue reading >>

Euglycemic Diabetic Ketoacidosis: A Potential Complication Of Treatment With Sodium–glucose Cotransporter 2 Inhibition

Euglycemic Diabetic Ketoacidosis: A Potential Complication Of Treatment With Sodium–glucose Cotransporter 2 Inhibition

OBJECTIVE Sodium–glucose cotransporter 2 (SGLT-2) inhibitors are the most recently approved antihyperglycemic medications. We sought to describe their association with euglycemic diabetic ketoacidosis (euDKA) in hopes that it will enhance recognition of this potentially life-threatening complication. RESEARCH DESIGN AND METHODS Cases identified incidentally are described. RESULTS We identified 13 episodes of SGLT-2 inhibitor–associated euDKA or ketosis in nine individuals, seven with type 1 diabetes and two with type 2 diabetes, from various practices across the U.S. The absence of significant hyperglycemia in these patients delayed recognition of the emergent nature of the problem by patients and providers. CONCLUSIONS SGLT-2 inhibitors seem to be associated with euglycemic DKA and ketosis, perhaps as a consequence of their noninsulin-dependent glucose clearance, hyperglucagonemia, and volume depletion. Patients with type 1 or type 2 diabetes who experience nausea, vomiting, or malaise or develop a metabolic acidosis in the setting of SGLT-2 inhibitor therapy should be promptly evaluated for the presence of urine and/or serum ketones. SGLT-2 inhibitors should only be used with great caution, extensive counseling, and close monitoring in the setting of type 1 diabetes. Sodium–glucose cotransporter 2 (SGLT-2) inhibitors are the newest class of antihyperglycemic medications, first marketed in 2013 for the treatment of type 2 diabetes (1). Limited studies suggest that SGLT-2 inhibitors may be effective in addressing many of the unmet needs of people with type 1 diabetes, including improving average glycemia, while reducing glycemic variability and postprandial hyperglycemia, without increasing hypoglycemia, as well as promoting weight loss while reducing insulin dose Continue reading >>

Euglycemic Diabetic Ketoacidosis: The Clinical Concern Of Sglt2 Inhibitors

Euglycemic Diabetic Ketoacidosis: The Clinical Concern Of Sglt2 Inhibitors

Euglycemic diabetic ketoacidosis is a post market warning in patients with type 1 diabetes and type 2 diabetes treated with SGLT-2 inhibitors. We report a case of a 39-year-old obese female with presumed type 2 diabetes for seven years who presented to the emergency department with three days of nausea, vomiting, and abdominal pain. Due to previous total non-adherence with a prescribed insulin regimen, she was recently started on canagliflozin and liraglutide. The diagnosis of euDKA was missed in the initial evaluation as the blood glucose level was only 167 mg/dL. Further work up showed severe metabolic acidosis with an anion gap of 25 and positive ketones in the urine. She was treated successfully with dextrose water 5%/half normal saline and an insulin drip. As part of the work up, she tested positive for glutamic acid decarboxylase autoantibodies. Given the increasing utilization of SGLT-2 inhibitors and the fact that patients can present with near-normal glycemia, the diagnosis can be missed. Vigilance with the use of SGLT-2 inhibitors is necessary to decrease morbidity and potentially mortality particularly in patients with long-standing type 2 diabetes associated with marked β-cell insufficiency, type 1 diabetes mellitus, or latent autoimmune diabetes of adult onset. 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 >>

Euglycaemic Diabetic Ketoacidosis In Pregnancy

Euglycaemic Diabetic Ketoacidosis In Pregnancy

Euglycaemic Diabetic ketoacidosis in pregnancy 1Centre for Diabetes and Endocrinology, Royal Berkshire Hospital, Reading, UK; 2Centre for Diabetes and Endocrinology, Royal Berkshire Hospital, Reading, UK. Diabetic ketoacidosis (DKA) affects 1-3 percent of pregnancies complicated by diabetes but can result in significant morbidity and mortality for mother and foetus. Euglycaemia in DKA is a recognised but infrequent presentation. It was originally defined as initial blood glucose less than 16.7 millimol per litre and bicarbonate less than 10 millimol per litre. A 29-year old female with type 1 diabetes for 10 years presented at 25 weeks gestation with a 2 day history of vomiting and abdominal pain. General and systemic examination was unremarkable apart from mild epigastric tenderness. Blood glucose was 14.1 millimol per litre. Urinalysis showed +++ ketones but was negative for glucose. She was admitted for observation and obstetric review. Twelve hours later she was seen with a respiratory rate of 40 and heart rate 120. Blood glucose was 13.4 and arterial blood gas showed pH 7.095, pCO2 0.86kPa, pO2 17.1kPa, bicarbonate 5.9 millimol per litre, lactate 1.4 millimol per litre and base excess minus 28.1. She was admitted to ITU and treated with intravenous fluids and insulin sliding scale. The acidosis improved and she was discharged from ITU 3 days later but was closely monitored on the maternity unit for the remainder of her pregnancy. She delivered a healthy baby at 37 weeks and both were well at last postnatal follow up. DKA can and does occur without abnormally high glucose levels. Predisposing factors for this in pregnancy include reduced carbohydrate intake secondary to vomiting, starvation-induced ketone production, continuous uptake of glucose by the foetus and t Continue reading >>

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