Keywords
Type 1 diabetes
Insulin therapy
Metabolic acidosis
Carbohydrate
Categories
How to Cite
Abstract
Introduction: Euglycemic diabetic ketoacidosis (EDKA) is an acute complication seen in insulin-deficient patients, occurring in only 2.6-3.2% of those with diabetic ketoacidosis (DKA). However, its incidence is significantly higher in pregnant diabetic patients, reaching up to 50% of DKA cases. These differences may be attributed to the specific characteristics of pregnancy, including increased counter-regulatory hormones, hyperketonemia, and limited nutritional intake. This case discusses the diagnosis, treatment, and frequency of this condition. Case Report: We present the case of a 37-year-old woman with type 1 diabetes, 33 weeks pregnant, who developed EDKA due to hyperemesis gravidarum. Metabolic acidosis was confirmed despite a serum glucose level of 175 mg/dL. Treatment included intravenous insulin, bicarbonate and appropriate intravenous glucose administration. Correct carbohydrate replenishment improved the patient's clinical condition, leading to stabilization. Conclusions: Prevention, early diagnosis, and proper treatment, including adequate carbohydrate management, are crucial to preventing complications for both the mother and the fetus.
References
C. Diguisto, M. W. J. Strachan, D. Churchill, G. Ayman, and M. Knight, A study of diabetic ketoacidosis in the pregnant population in the United Kingdom: Investigating the incidence, aetiology, management and outcomes, Diabet. Med. J. Br. Diabet. Assoc., vol. 39, no. 4, p. e14743, Apr. 2022, doi: 10.1111/dme.14743.
K. K. Dhatariya and P. Vellanki, Treatment of Diabetic Ketoacidosis (DKA)/Hyperglycemic Hyperosmolar State (HHS): Novel Advances in the Management of Hyperglycemic Crises (UK Versus USA), Curr. Diab. Rep., vol. 17, no. 5, p. 33, May 2017, doi: 10.1007/s11892-017-0857-4.
P. Rawla, A. R. Vellipuram, S. S. Bandaru, and J. Pradeep Raj, Euglycemic diabetic ketoacidosis: a diagnostic and therapeutic dilemma, Endocrinol. Diabetes Metab. Case Rep., vol. 2017, Sep. 2017, doi: 10.1530/EDM-17-0081.
X. Yu, S. Zhang, and L. Zhang, Newer Perspectives of Mechanisms for Euglycemic Diabetic Ketoacidosis, Int. J. Endocrinol., vol. 2018, p. 7074868, 2018, doi: 10.1155/2018/7074868.
P. Nasa, S. Chaudhary, P. K. Shrivastava, and A. Singh, Euglycemic diabetic ketoacidosis: A missed diagnosis, World J. Diabetes, vol. 12, no. 5, pp. 514–523, May 2021, doi: 10.4239/wjd.v12.i5.514.
V. H. Córdova-Pluma, C. A. Vega-López, I. Martínez-Martínez, F. Delgado-Ayala, and M. J. Ortega-Chavarría, Cetoacidosis diabética euglucémica secundaria a la administración de inhibidor del SGLT2, Med. Interna México, 2019.
A. Modi, A. Agrawal, and F. Morgan, Euglycemic Diabetic Ketoacidosis: A Review, Curr. Diabetes Rev., vol. 13, no. 3, pp. 315–321, May 2017, doi: 10.2174/1573399812666160421121307.
S. Wazir et al. Euglycemic ketoacidosis in pregnancy with COVID-19: A case report and literature review. Clin. Case Rep., vol. 10, no. 4, p. e05680, Apr. 2022, doi: 10.1002/ccr3.5680.J. F. Jaber, M. Standley, and R. Reddy, Euglycemic Diabetic Ketoacidosis in Pregnancy: A Case Report and Review of Current Literature, Case Rep. Crit. Care, vol. 2019, p. 8769714, 2019, doi: 10.1155/2019/8769714.
Introducción y metodología: Estándares de atención en diabetes 2024 | Atención de la diabetes | Asociación Estadounidense de Diabetes. Accessed: Aug. 05, 2024. [Online]. Available: https://diabetesjournals.org/care/article/47/Supplement_1/S1 /153952/Introduction-and-Methodology-Standards-of-Care-in
T. Eshkoli, L. Barski, Y. Faingelernt, A. Jotkowitz, A. Finkel-Oron, and D. Schwarzfuchs, Diabetic ketoacidosis in pregnancy – Case series, pathophysiology, and review of the literature, Eur. J. Obstet. Gynecol. Reprod. Biol., vol. 269, pp. 41–46, Feb. 2022, doi: 10.1016/j.ejogrb.2021.12.011.
R. Guo, L. Yang, L. Li, and X. Zhao, Diabetic ketoacidosis in pregnancy tends to occur at lower blood glucose levels: Case–control study and a case report of euglycemic diabetic ketoacidosis in pregnancy, J. Obstet. Gynaecol. Res., vol. 34, no. 3, pp. 324–330, Jun. 2008, doi: 10.1111/j.1447-0756.2008.00720.x.
V. A. Mustad, D. T. T. Huynh, J. M. López-Pedrosa, C. Campoy, and R. Rueda, The Role of Dietary Carbohydrates in Gestational Diabetes, Nutrients, vol. 12, no. 2, p. 385, Jan. 2020, doi: 10.3390/nu12020385.
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