Diabetic Ketoacidosis in Pregnancy
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 %.
KeywordsCerebral Edema Sodium Chloride Solution Diabetic Ketoacidosis Antenatal Corticosteroid Fetal Lung Maturity
- 1.ACOG Practice Bulletin. Clinical Management Guidelines for Obstetrician-Gynecologists. Number 60, 2005.Google Scholar
- 2.INTECH ©2013 Abdelghaffar. Diabetic Ketoacidosis: clinical practice guidelines. Chapter 11. http://dx.doi.org/10.5772/53020.
- 3.National Institute for Health & Clinical Excellence (NHS). Diabetes in Pregnancy; Management of diabetes & its complications from pre-conception to the postnatal period. 2008. Last modified July 2008Google Scholar
- 4.National Institute for Health & Clinical Excellence (NHS). Joint British Diabetes Societies Inpatient Care Group. 2010.Google Scholar