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Perinatal/Neonatal Case Presentation

Normoglycemic diabetic ketoacidosis in pregnancy


The clinical presentation of diabetic ketoacidosis in pregnancy is usually the same as in nonpregnant women, although the blood glucose may not be as high as in the nongravid state. We report a case of a pregnant woman who developed diabetic ketoacidosis with a normal blood glucose and review the pertinent medical literature. A 29-year-old woman with type I diabetes developed diabetic ketoacidosis during induction of labor. She had a glucose level of 87 mg per 100 ml with ketonuria, a metabolic acidosis, and an anion gap of 20 mmol l−1. Normoglycemic diabetic ketoacidosis during pregnancy is truly unusual but can occur with relatively low, or even normal, blood sugars and necessitates prompt recognition and treatment. In this case, the combination of an initial episode of hypoglycemia and subsequent blood glucose levels below 95 mg per 100 ml led to a prolonged delay in the initiation of a planned insulin infusion for insulin coverage during the induction of labor. A significant ketoacidosis consequently developed, despite the absence of even a single elevated blood glucose measurement. This case illustrated the importance of not withholding insulin in a patient with type I diabetes for more than a few hours even if the blood glucose is normal.

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  1. Brumfield CG, Huddleston JF . The management of diabetic ketoacidosis in pregnancy. Clin Obstet Gynecol 1984; 27: 50–59.

    Article  CAS  Google Scholar 

  2. Carroll MA, Yeomans ER . Diabetic ketoacidosis in pregnancy. Crit Care Med 2005; 33: S347–S353.

    Article  Google Scholar 

  3. Kamalakannan D, Baskar V, Barton DM, Abdu TAM . Diabetic ketoacidosis in pregnancy. Postgrad Med J 2003; 79: 454–457.

    Article  CAS  Google Scholar 

  4. Ramin KD . Diabetic ketoacidosis in pregnancy. Obstet and Gynecol Clin North Am 1999; 26: 482–488.

    Google Scholar 

  5. Metzger BE, Ravnikar V, Vileisis RA, Freinkel N . ‘Accelerated starvation’ and the skipped breakfast in late normal pregnancy. Lancet 1982; 1 (8272): 588–592.

    Article  CAS  Google Scholar 

  6. Cullen MT, Reece EA, Homko CJ, Sivan E . The changing presentations of diabetic ketoacidosis during pregnancy. Am J Perinatol 1996; 13: 449–451.

    Article  CAS  Google Scholar 

  7. Montoro MN, Myers VP, Mestman JH, Xu Y, Anderson BG, Golde SH . Outcome of pregnancy in diabetic ketoacidosis. Am J Perinatol 1993; 10: 17–20.

    Article  CAS  Google Scholar 

  8. American College of Obstetricians and Gynecologists. ACOG practice bulletin No. 60: pregestational diabetes. Obstet Gynecol 2005; 105: 675–685.

    Article  Google Scholar 

  9. Clark JD, McConnell A, Hartog M . Normoglycaemic ketoacidosis in a woman with gestational diabetes. Diabet Med 1991; 8: 388–389.

    Article  CAS  Google Scholar 

  10. Franke B, Carr D, Hatem MH . A case of euglycaemic diabetic ketoacidosis in pregnancy. Diabet Med 2001; 18: 858–859.

    Article  CAS  Google Scholar 

  11. Kitabchi AE, Umpierrez GE, Murphy MB, Barrett EJ, Kreisberg RA, Malone JI et al. Management of hyperglycemic crises in patients with diabetes. Diabetes Care 2001; 24: 131–153.

    Article  CAS  Google Scholar 

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We would like to acknowledge and thank Dr David E. Scarborough for his thoughtful review and suggestions in the preparation of this manuscript. This work was funded by the departmental resources. This paper was presented as a poster at the Annual Meeting of the Endocrine Society, June 2006, Boston, MA, USA.

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Correspondence to S N Levine.

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Chico, M., Levine, S. & Lewis, D. Normoglycemic diabetic ketoacidosis in pregnancy. J Perinatol 28, 310–312 (2008).

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  • diabetic ketoacidosis
  • pregnancy
  • diabetes mellitus, type I
  • blood glucose

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