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Federación Mexicana de Ginecología y Obstetricia, A.C.

2020, Number 07

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Ginecol Obstet Mex 2020; 88 (07)

Diabetic ketoacidosis in pregnancy: a case report

Guevara-Valerio H, Mari-Zapata DD, Arévalo-Villa DI, Vargas-Aguilar DM, Etulain-González JE

Language: Spanish
References: 17
Page: 471-476
PDF size: 186.84 Kb.


ABSTRACT

Background: Diabetic ketoacidosis is a serious complication of diabetes that often results in a medical emergency. It usually occurs in patients with type 1 diabetes mellitus, especially newly developed, but it can also affect women with type 2 diabetes and rarely women with gestational diabetes (1-3% of all patients with diabetes during the pregnancy).
Objective: To present a case report of a pregnant woman who presented with diabetic ketoacidosis, treatment and evolution. Given the low frequency of the pathology, it is interesting to report and review the current literature.
Clinical cases: A 32-year-old woman, with the diagnosis of decompensated type 2 diabetes mellitus, 40.1 weeks of gestation, who goes to a first level hospital for presenting; arterial tensions of 145 / 95mmHg, pain in epigastrium, irregular uterine activity, nausea and vomiting for what is referred to the General Hospital of Chimalhuacán. The patient enters the emergency department with, blood pressure 145/96 mmHg, heart rate 87x`, temperature 37.2 oC Fetal heart rate 180 beats per minute sustained, laboratory studies found glycaemia of 553 mg/dL, ketonemia, pH 7.3, fetal heart rate 180 beats per minute sustained so it is decided to terminate the pregnancy by caesarean section. According to the diagnostic criteria of diabetic ketoacidosis, the diagnosis of moderate diabetic ketoacidosis is established.
Conclusions: Diabetic ketoacidosis is a rare but serious complication of diabetes in pregnancy, with harmful consequences for both the fetus and the mother. Rapid actirecognition of precipitating factors, initial fluid therapy, insulin administration and correction of hydroelectrolytic imbalance are priorities in the management of diabetic ketoacidosis. A multidisciplinary management that includes intensive care unit for the mother and neonatal intensive care, monitoring the maternal response to treatment is essential to reduce morbidity and mortality; fetal monitoring is necessary, as this will be directly affected or benefited according to the maternal response to treatment.


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