Euglycaemic diabetic ketoacidosis (DKA) during pregnancy is a life-threatening obstetric emergency.It requires early identification and prompt action. Obstetricians’ knowledge about symptoms, diagnostic pitfalls and management during pregnancy and delivery need to be improved.
Pre-eclamptic toxaemia (PET) is a disease manifesting in the third trimester, with symptoms related to hypertension, including vision changes, nausea, vomiting, and headache, as well as right upper quadrant pain, hyper-reflexia, clonus, feel ing of jitteriness, and biochemical markers such as thrombo cytopaenia and elevated liver enzymes, uric acid and lactate dehydrogenase (LDH)
Here we describe a case of euglycaemic DKA in pregnancy which presented with symptoms of PET, leading to emer gency management which greatly exacerbated the severity of the ketoacidosis.
Diabetic ketoacidosis (DKA) in pregnancy is associated with high fetal mortality rates. A small percentage of DKA occurs in the absence of high glucose levels seen in traditional DKA. Prompt recognition and management is crucial. We report a case of a 30-year old pregnant woman with hipertansion admitted with euglycemic DKA (blood glucose <200mg/dL). Initial laboratory testing revealed a severe anion gap acidosis with pH 7.11, anion gap 23, and a blood glucose of 183mg/dL—surprisingly low given her severe acidosis. ketoacidosis persisted despite high doses of glucose and insulin infusions. Due to nonresolving acidosis, her hospital course was complicated by intensive care unit hospitilization.. This case highlights that severe ketonemia can occur despite the absence of severely elevated glucose levels. We discuss the mechanism that leads to this pathophysiologic state .
Anahtar Kelimeler: Euglycaemic ketoacidosis, Pregnancy,Pre-eklempsik toxemia
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