1/6. diabetic ketoacidosis. A rare complication of gestational diabetes.OBJECTIVE--To describe a case of severe DKA in an otherwise healthy pregnant woman. research design AND methods--We describe 2.5 yr of close follow-up of a Bedouin woman who was hospitalized for DKA while pregnant with her 11th child. Plasma glucose returned to normal levels immediately after delivery of a dead conceptus. Four months later, while normoglycemic, the patient became pregnant again. During the subsequent pregnancy, GDM was diagnosed at week 20 of gestation. Tight plasma glucose control was achieved with an insulin regimen, and the patient delivered a healthy girl at term. Plasma glucose again returned to normal and remained so to date, 18 mo postpartum. An OGTT and a euglycemic hyperinsulinemic clamp were performed between pregnancies; another OGTT was performed at week 14 of the last pregnancy. Plasma glucose, insulin, and c-peptide were measured in blood samples during these procedures. RESULTS--We established beyond doubt that the patient developed GDM and returned to essentially normal glucose tolerance after her last (12th) delivery. During the 11th pregnancy, gestational diabetes was complicated by severe DKA. CONCLUSIONS--GDM is a common abnormality of glucose metabolism during pregnancy, which affects fetal development and leads to peripartum complications. Our report stresses that under certain circumstances, gestational diabetes can be complicated by DKA and become life-threatening to the mother and fetus.- - - - - - - - - - ranking = 1keywords = ketoacidosis (Clic here for more details about this article) |
2/6. Extreme gestational starvation ketoacidosis: case report and review of pathophysiology.A case of severe starvation ketoacidosis developing during pregnancy is presented. The insulinopenic/insulin-resistant state found during fasting in late gestation predisposes to ketosis. Superimposition of stress hormones, which further augment lipolysis, exacerbates the degree of ketoacidosis. In our patient, gestational diabetes, twin pregnancies, preterm labor, and occult infection were factors that contributed to severe starvation ketoacidosis. diagnosis was delayed because starvation ketosis is not generally considered to be a cause of severe acidosis, and because the anion gap was not elevated. Improved understanding of the complex fuel metabolism during pregnancy should aid in prevention, early recognition, and appropriate therapy of this condition.- - - - - - - - - - ranking = 1.75keywords = ketoacidosis (Clic here for more details about this article) |
3/6. Wernicke's encephalopathy with hyperemesis and ketoacidosis.BACKGROUND: avitaminosis can result from the acute malnutrition associated with prolonged pregnancy-related hyperemesis. Serious complications may arise from thiamine deficiency under these circumstances. CASE: We review the relevant literature and describe a case with central nervous system involvement presenting with typical manifestations of Wernicke's encephalopathy, apparently precipitated by a combination of hyperemesis gravidarum, diabetic ketoacidosis, and intravenous glucose administration. CONCLUSION: While this life-threatening complication is rare, it is important for all who care for obstetric patients to be aware of it and alert to its development. Early recognition is critical given the need to treat affected women expeditiously to help avoid potentially fatal adverse consequences. Prophylactic thiamine supplementation should be considered in the care of gravidas with hyperemesis.- - - - - - - - - - ranking = 1.25keywords = ketoacidosis (Clic here for more details about this article) |
4/6. diabetic ketoacidosis in pregnancy.diabetic ketoacidosis, though uncommon, is a very serious complication in obstetrics. We reported 5 cases, which in retrospect could all have been prevented from occurring. Either a strong family of diabetes mellitus or presence of glycosuria were present in 4 cases. In 3 cases, the use of sympathomimetic and corticosteroid was the predisposing factor. Clinicians should have an index of suspicion in patients at risk and it might be prudent to screen for diabetes where the use of sympathomimetic and corticosteroid.- - - - - - - - - - ranking = 1.25keywords = ketoacidosis (Clic here for more details about this article) |
5/6. Gestational diabetes mellitus with profound insulin resistance. A case report.Gestational diabetes resistant to insulin therapy occurring in association with insulin receptor antibodies has not been reported previously. A patient developed diabetes mellitus at 21 weeks' gestational age and had a previous history of thrombotic thrombocytopenia purpura, then in remission. She developed life-threatening diabetic ketoacidosis that was severely resistant to insulin treatment despite the usage of adjunct therapy, including plasmapheresis, and intravenous cyclophosphamide and steroids. She also had lupus nephropathy. Termination of the pregnancy at 22 weeks' gestation resulted in a rapid resolution of both the diabetes and lupus nephropathy.- - - - - - - - - - ranking = 0.25keywords = ketoacidosis (Clic here for more details about this article) |
6/6. Glucocorticoid-induced ketoacidosis in gestational diabetes: sequela of the acute treatment of preterm labor. A case report.pregnancy induces complex changes in energy metabolism, manifested clinically by insulin resistance, low fasting blood glucose levels, and proneness to ketosis. It is quite unusual for pregnant women who do not have type I diabetes to progress from ketosis to frank ketoacidosis, although this phenomenon is common in larger mammals. In the case described here, glucocorticoid administration in the setting of a prolonged fast triggered a metabolic cascade leading to ketoacidosis in a pregnant woman without type 1 diabetes. Other details of this illustrative case serve to synthesize several disparate observations regarding the pathogenesis of pregnancy ketoacidosis. physicians should be aware of the potential for rapidly developing ketoacidosis with atypical biochemical and clinical features in pregnant women who are treated with high doses of glucocorticoids.- - - - - - - - - - ranking = 2keywords = ketoacidosis (Clic here for more details about this article) |