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DKA pregnancy

Anar Modi, Abhinav Agrawal, Farah Morgan
INTRODUCTION: Diabetic ketoacidosis (DKA) is one of the most serious complications of diabetes. It is characterised by the triad of hyperglycemia (blood sugar >250 mg/dl), metabolic acidosis (arterial pH <7.3 and serum bicarbonate <18 mEq/L) and ketosis. Rarely these patients can present with blood glucose (BG) levels of less than 200 mg/dl, which is defined as euglycemic DKA. The possible etiology of euglycemic DKA includes the recent use of insulin, decreased caloric intake, heavy alcohol consumption, chronic liver disease and glycogen storage disorders...
April 21, 2016: Current Diabetes Reviews
Maria Grazia Dalfrà, Silvia Burlina, Giovanni Sartore, Annunziata Lapolla
Diabetic ketoacidosis (DKA) is a serious medical and obstetrical emergency previously considered typical of type 1 diabetes but now reported also in type 2 and GDM patients. Although it is a fairly rare condition, DKA in pregnancy can compromise both fetus and mother. Metabolic changes occurring during pregnancy predispose to DKA in fact it can develop even in setting of normoglycemia. This article will provide the reader with information regarding the pathophysiology underlying DKA, in particular euglycemic DKA, and will provide information regarding all possible effects of ketones on the fetus...
September 2016: Journal of Maternal-fetal & Neonatal Medicine
Rozalyn Love, Amy Lee, April Matiasek, William Carter, Marissa Ylagan
Introduction Encephalomalacia in a developing fetus is a rare and devastating neurological finding on radiologic imaging. Maternal diabetic ketoacidosis (DKA) can lead to metabolic and vascular derangements which can cause fetal encephalomalacia. Case We report the case of a 27-year-old pregnant woman with White's Class C diabetes mellitus who presented in the 25th week of gestation with DKA. Four weeks after her discharge, marked fetal cerebral ventriculomegaly was noted on ultrasound. A subsequent fetal magnetic resonance imaging (MRI) demonstrated extensive, symmetric cystic encephalomalacia, primarily involving both cerebral hemispheres...
November 2014: American Journal of Perinatology Reports
Hiromi Himuro, Takashi Sugiyama, Hidekazu Nishigori, Masatoshi Saito, Satoru Nagase, Junichi Sugawara, Nobuo Yaegashi
UNLABELLED: Diabetic ketoacidosis (DKA) during pregnancy is a serious complication in both mother and fetus. Most incidences occur during late pregnancy in women with type 1 diabetes mellitus. We report the rare case of a woman with type 1 diabetes mellitus who had normal glucose tolerance during the first trimester but developed DKA during late pregnancy. Although she had initially tested positive for screening of gestational diabetes mellitus during the first trimester, subsequent diagnostic 75-g oral glucose tolerance tests showed normal glucose tolerance...
2014: Endocrinology, Diabetes & Metabolism Case Reports
Etoi A Garrison, Shubhada Jagasia
For women with type 1 diabetes (T1DM), type 2 diabetes (T2DM), and gestational diabetes (GDM), poor maternal glycemic control can significantly increase maternal and fetal risk for adverse outcomes. Outpatient medical and nutrition therapy is recommended for all women with diabetes in order to facilitate euglycemia during the antepartum period. Despite intensive outpatient therapy, women with diabetes often require inpatient diabetes management prior to delivery as maternal hyperglycemia can significantly increase neonatal risk of hypoglycemia...
February 2014: Current Diabetes Reports
Margarita de Veciana
Diabetic ketoacidosis (DKA) is a serious medical and obstetrical emergency usually occurring in patients with type 1 (insulin-dependent) diabetes mellitus. Although modern management of the patient with diabetes should prevent the occurrence of DKA during pregnancy, this complication still occurs and can result in significant morbidity and mortality for mother and/or fetus. Metabolic changes occurring during pregnancy can predispose a pregnant diabetic to DKA. The diagnosis of DKA can be more challenging during pregnancy as it does not always manifest with the classic presenting symptoms or laboratory findings...
August 2013: Seminars in Perinatology
Monika Madaan, Kiran Aggarwal, Ritu Sharma, Shubha Sagar Trivedi
BACKGROUND: Euglycemic diabetic ketoacidosis (DKA) during pregnancy is an unusual condition, but it can occur with normal or modest elevations in blood glucose levels. It is usually a complication of type I diabetes. CASES: We report two cases of euglycemic DKA, in type II diabetes mellitus and in gestational diabetes. Both patients showed blood glucose levels up to 9 mmoL/L (164 mg/dL), ketonuria and metabolic acidosis. They responded to initiation of correct insulin dosages...
September 2012: Journal of Reproductive Medicine
David A Horwitz, Evan S Schwarz, Mitchell G Scott, Lawrence M Lewis
OBJECTIVES: The objective was to determine if emergency department (ED) patients with diabetes mellitus (DM) who have primary care providers (PCPs) have better control of their DM than patients with no PCPs. METHODS: This was a prospective, cross-sectional, observation study at a large, adult, urban, academic ED with 85,000 annual visits. ED patients with a history of DM were eligible. Patients with severe systemic disease, diabetic ketoacidosis (DKA), sepsis, active steroid use, pregnancy, or cognitive impairment were excluded...
June 2012: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
A Napoli, M Framarino, A Colatrella, G Merola, M Trappolini, V Toscano, V Talucci, D Iafusco
OBJECTIVE: To describe a case of diabetic ketoacidosis (DKA) in a pregnant woman with type 1 diabetes (T1DM) and disordered eating behaviour treated with a continuous subcutaneous insulin infusion, and to discuss some aspects of the monitoring and management of DKA in pregnancy and whether a pump is the safest therapeutic choice in the presence of some eating disorders. CASE REPORT: This 26-year-old Caucasian woman affected by T1DM was hospitalised during the last weeks of her fourth pregnancy because of DKA due to disordered eating...
June 2011: Eating and Weight Disorders: EWD
Matthew B Stenerson, Christopher A Collura, Carl H Rose, Aida N Lteif, William A Carey
Diabetic ketoacidosis (DKA) during pregnancy carries significant risk of intrauterine fetal demise, but little is known about its postnatal sequelae in surviving neonates. We report here the case of an infant who was born to a mother with White's class C diabetes mellitus during an episode of DKA. Throughout pregnancy her glucose control was suboptimal, as evidenced by a predelivery glycosylated hemoglobin level of 8.1%. At 33 weeks' gestation, the mother presented with nausea and vomiting, a serum glucose concentration of 575 mg/dL, and other metabolic derangements consistent with DKA...
September 2011: Pediatrics
Elaine M Wolfson, Adriane DeKalb, Ariella Rojhani
Although women's health has been under-attended for most of the 20th century, it has gained international attention in recent decades. Medical and social research on heart disease, lung cancer, HIV/AIDS, and trachoma indicate that bio-socio variables affect women's health differently from men's. With regard to diabetes, data on pregnancy, diabetic ketoacidosis (DKA), depression, and heart disease corroborate the differentials between men and women. Data also indicate that social factors place diabetic women at a disadvantage regarding access to treatment and outcomes...
March 2009: International Journal of Gynaecology and Obstetrics
Rui-Xia Guo, Ling-Zhu Yang, Liu-Xia Li, Xue-Ping Zhao
BACKGROUND AND OBJECTIVE: The occurrence of diabetic ketoacidosis (DKA) during pregnancy is considered a medical emergency. The aims of the present study were to evaluate the incidence of DKA in pregnant and non-pregnant women with diabetes; to compare the blood glucose levels at the diagnosis of DKA in pregnant and non-pregnant women; and to show a case of euglycemic DKA in pregnancy. METHODS: The subjects consisted of 90 cases of DKA in pregnant women with diabetes and 286 cases of non-pregnant female inpatients receiving treatment for diabetes during 2001 to 2005 in our hospital...
June 2008: Journal of Obstetrics and Gynaecology Research
Nauman Tarif, Wisam Al Badr
Diabetic ketoacidosis (DKA) can be a catastrophic event during pregnancy, complicating almost nine percent of diabetics in pregnancy. It induces both maternal and fetal mortality. Ketosis has been implicated in fetal distress and causes adverse neurological outcome. DKA with a relatively low blood sugar levels is called euglycemic DKA, which is a rare entity and reported usually in type I diabetic patients. A 37-year-old Saudi female patient known to have type II diabetes developed euglycemic [blood glucose level 4...
November 2007: Saudi Journal of Kidney Diseases and Transplantation
Jason A Parker, Deborah L Conway
Episodes of diabetic ketoacidosis (DKA) can represent a life-threatening emergency for mother and fetus. The cornerstones of treatment of DKA are aggressive fluid replacement and insulin administration while ascertaining which precipitating factors brought about the current episode of DKA, and then treating accordingly to mitigate those factors. The incidence of DKA and factors unique to pregnancy are discussed in this article, along with the effects of the disease process on pregnancy. Clinical presentation, diagnosis, and treatment modalities are covered in detail to offer ideas to improve maternal and fetal outcome...
September 2007: Obstetrics and Gynecology Clinics of North America
Rony Chen, Avi Ben-Haroush, Alina Weismann-Brenner, Alina Weissman-Brenner, Nir Melamed, Moshe Hod, Yariv Yogev
OBJECTIVE: We aimed to compare glycemic control and pregnancy outcome in type I diabetic patients treated by 2 modes of treatment: multiple daily injections of insulin (MDI) and continuous subcutaneous insulin infusions (CSII). STUDY DESIGN: In a retrospective, matched-control study, patients treated by MDI were compared with patients treated by CSII in a ratio of 2:1. Level of glycemic control and pregnancy outcome was compared. RESULTS: Overall, 90 women were evaluated; of them 30 were treated by CSII and 60 by MDI...
October 2007: American Journal of Obstetrics and Gynecology
Anil Bhansali, Arijit Chattopadhyay, Radharaman Jiban Dash
Cause(s) of death in patients with diabetes mellitus (DM) admitted to a tertiary care hospital in North India was analysed from classified information in patients' death records and case file. Of the 306652 total admissions from 1991 to 1999, 21584 patients died (7.04%), 592 of whom (355 men and 237 women) had DM (2.7%). Information from 92 patients with diabetes could not be retrieved and six patients with hyperglycemia of short duration (two with gestational DM, three with post-transplant diabetes and one with stress hyperglycemia) were excluded...
May 2003: Diabetes Research and Clinical Practice
Takeshi Inagaki, Yutaka Nishii, Naomi Suzuki, Satoru Suzuki, Yoichi Koizumi, Toru Aizawa, Kiyoshi Hashizume
We report two cases of type 1 diabetes mellitus fulminantly developed as diabetic ketoacidosis (DKA) at 19 weeks of gestation and immediately after delivery. Development of type 1 diabetes around pregnancy is not rare, but its fulminant development is highly uncommon. We also review the relevant literature concerning mostly Japanese cases. In our cases, the group of patients with fulminant progressive diabetes mellitus associated with pregnancy required insulin replacement therapy even after the acute period and showed high value of pancreatic exocrine enzymes, i...
June 2002: Endocrine Journal
L Laffel
Ketone bodies are produced by the liver and used peripherally as an energy source when glucose is not readily available. The two main ketone bodies are acetoacetate (AcAc) and 3-beta-hydroxybutyrate (3HB), while acetone is the third, and least abundant, ketone body. Ketones are always present in the blood and their levels increase during fasting and prolonged exercise. They are also found in the blood of neonates and pregnant women. Diabetes is the most common pathological cause of elevated blood ketones. In diabetic ketoacidosis (DKA), high levels of ketones are produced in response to low insulin levels and high levels of counterregulatory hormones...
November 1999: Diabetes/metabolism Research and Reviews
K D Ramin
Diabetic ketoacidosis (DKA) remains a medical emergency with high maternal and fetal mortality. Prompt recognition and resuscitative therapy markedly improves outcome. The pathophysiology and management of DKA in pregnancy is discussed in detail in this article.
September 1999: Obstetrics and Gynecology Clinics of North America
M T Cullen, E A Reece, C J Homko, E Sivan
The purpose of the present study was to examine the presentation and outcomes associated with diabetic ketoacidosis (DKA) in pregnancies complicated by diabetes. Eleven episodes (2%) of DKA were diagnosed during the 10-year study period. All patients were under close observation by the Diabetes-in-Pregnancy Service. Plasma glucose levels of less than 200 mg/dL were present in 4 of the 11 patients (36%), 10 (90%) of whom presented with nausea, vomiting, and decreased caloric intake. Two subsequently had fetal distress necessitating cesarean section...
October 1996: American Journal of Perinatology
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