Diabetic ketoacidosis can occur during pregnancy and can have serious complications for both mother and fetus. Early diagnosis and aggressive management can reduce morbidity and mortality.
Most patient have Type 1 diabetes, but it can also affect someone with Type 2 or gestational diabetes.
Most patients have an intrauterine pregnancy but rarely DKA can occur with an ectopic pregnancy.
Triggering events:
(1) stress
(2) fasting
(3) respiratory alkalosis
(4) severe infection
(5) poor glycemic control and/or insulin compliance
(6) pre-eclampsia
(7) trauma
(8) hyperemesis gravidarum
(9) corticosteroids or other drugs
The possibility of DKA should be considered in all pregnant women with diabetes. The patient may also have a history of a previous episode of diabetic ketoacidosis.
Initial testing should include:
(1) blood glucose
(2) testing for ketones in blood and urine
(3) serum bicarbonate
(4) venous pH
(5) evaluation for dehydration
(6) serum electrolytes
Some patients have euglycemic DKA. Failure to consider DKA with a lower blood glucose can delay diagnosis.
Complications:
(1) maternal death
(2) fetal death
