Ketoacodosis in pregnancy: normoglycemia does not rule out a ketoacodisis

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E.S. van der Valk, S.W. van Thiel, M.S. Lunshof

Voorzitter(s): prof. dr. M.M.E. Schneider, UMCU, Utrecht & dr. L.J.M. de Heide, Zorgroep Noorderbreedt, Leeuwarden

Woensdag 22 april 2015

15:00 - 16:00u in Zaal 0.4

Categorieën: parallelsessie (case reports/research)

Parallel sessie: Parallelsessie 3: Case reports/research

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A 26-year old woman, pregnant for 34+1weeks, known with diabetes mellitus type 1 ( HbA1c 57) was seen at the obstetric emergency department with sickness and vomiting since one day. Her glucose during the day was 12-15 mmol/L. The first hours of admittance her glucose stayed between 12-17mmol/L. A few hours later the internist was consulted. The patient revealed that she had not taken her insulin because of reduced intake due to vomiting. The glucose was 23 mmol/L and there was a critical ketoacidosis (pH 7.12). Fetal monitoring showed severe fetal distress, necessitating an urgent caesarian section, while the mother's glucoses were stabilized. After the caesarian section she was immediately transferred to the intensive care unit. The neonate had severe acidemia, with a pH <6.50 and was resuscitated for 11 minutes. The neonate was transferred to a neonatal intensive care unit, but died of asphyxia several hours after birth. Diabetic keto-acidosis is seen in type 1 as in type 2 diabetes ( 0.3-3 %). Because of the catabolic state in pregnancy it can occur in normoglycaemia. Predisposing factors include vomiting, the use of beta-mimetic drugs, infections, a history of insulin therapy omission, continuous subcutaneous insulin infusion, the use of glucocorticoids (for fetal lung maturation) and diabetic gastroparesis. Doctors of all kind should be aware of the different mechanism of ketoacidosis in the pregnant diabetic patient, because of the severe consequences. A diabetic pregnant patient who presents with vomiting or fasting is ketoacidotic until the contrary is proven.