2025, Number 1
Clinical presentation, diagnosis, and treatment of patients with diabetic ketoacidosis during pregnancy and the postpartum period treated in a tertiary care unit
Díaz-Aguilar FA, Reyes-Miranda RA, Chablé-Chan FG, Gurrola-Gómez CA, Calva-Salinas KL, Helue-Mena A
Full text
10.35366/120930
Language: Spanish
References: 20
Page: 15-24
PDF size: 310.24 Kb.
ABSTRACT
Introduction: diabetic ketoacidosis (DKA) during pregnancy and the postpartum period represents a critical medical complication with serious implications for maternal and fetal health. Despite its severity, there are limitations in knowledge about its clinical characteristics, diagnosis, and management in specialized hospital settings. Given the variability in global incidence and the significant associated risks, it is imperative to explore these aspects in depth to optimize care and improve outcomes.Objective: to describe the clinical picture, diagnosis, and treatment of patients with diabetic ketoacidosis during pregnancy and the postpartum period who were treated in the intensive care unit of the Gynecology and Obstetrics Hospital No. 3 “Dr. Víctor Manuel Espinosa de los Reyes Sánchez” of the National Medical Center “La Raza”.
Material and methods: this is an analytical, observational, retrospective, descriptive, and longitudinal study; It is based on the review of clinical records of patients diagnosed with DKA during pregnancy and the postpartum period, treated from January 2019 to June 2024. The American Diabetes Association (ADA) criteria for the diagnosis of DKA were applied (pH ‹7.30, blood glucose ›200 mg/dL, positive ketonuria) and the information was taken from the records using a data collection sheet, without including identifiable information.
Results: nine cases were included. The median age was 27 years (IQR 22 - 37), gestational age at presentation was 28.6 weeks (IQR 18.6 - 37), with five patients (55.6%) diagnosed in the third trimester. The type of diabetes: type 1 diabetes mellitus (DM1) in 44.4%, gestational 33.3% and type 2 diabetes mellitus (DM 2) in 22.2%. The time of evolution of diabetes was less than 1 year in 66.7%. The most frequent comorbidity was obesity (33.3%). Lack of adherence to treatment was the most frequent precipitating factor (66.6%). Within the clinical picture that occurred most frequently: náuseas (77.8%) and vomiting (66.7%). Management in the ICU after 12 hours of stay, showed significant improvement in: heart rate (112 bpm vs 90 bpm, p = 0.98), pH (7.25 vs 7.37, p = 0.001), bicarbonate (11.8 mmol / L vs 16.4 mmol / L, p = 0.005), base excess (-18.1 mmol / L vs -11.1 mmol / L, p = 0.001) and the anion gap (17.2 vs 11 mmol / L, p = 0.007). Medical treatment: no one received insulin loading; insulin infusion dose used during the 12 hours was 0.040 IU/kg/h (IQR 0.014 – 0.055) and fluids infused in 12 hours was 3000 mL (IQR 1555 mL – 3391.5 mL). 66.7% of patients were discharged from the ICU after 2 days of stay.
Conclusion: diabetic ketoacidosis in pregnancy and puerperium is more frequently manifested in DM1 and gestational diabetes precipitated by the lack of metabolic control and a duration of diabetes less than one year. The predominant clinical picture is náuseas and vomiting; the management received in 12 hours includes fluids and intravenous insulin infusion, achieving discharge after 2 days of care.
REFERENCES
Cabrera-Figueredo I, Luaces-Sánchez P, Cruz-Fernández CYde la, González-Reigada A, Cabrera-Figueredo I, Luaces-SánchezP, et al. Cetoacidosis diabética normoglucémica en mujerescon diabetes gestacional. Rev Arch Méd Camagüey[Internet]. abril de 2020 [citado 25 de octubre de 2024];24(2). Disponibleen: http://scielo.sld.cu/scielo.php?script=sci_abstract&pid=S1025-02552020000200013&lng=es&nrm=iso&tlng=es