1/16. Reversal of foetal hydrops and foetal tachyarrhythmia associated with maternal diabetic coma.Foetal hydrops is always a challenge for the clinician. We report a case of tachycardia associated with hydrops and hydramnios in a pregnancy complicated with diabetic coma at 28 weeks gestation. Normal foetal heart rate was recorded immediately after correction of maternal acidotic status and hydrops eventually disappeared. The woman was delivered at 32 weeks and the baby had an uncomplicated postnatal course. We hypothesise that maternal ketoacidosis has been the precipitating factor of tachycardia and congestive heart failure and that this case is conceptually similar to the "late death" phenomenon, reported in cases of poorly controlled maternal diabetes.- - - - - - - - - - ranking = 1keywords = ketoacidosis (Clic here for more details about this article) |
2/16. Nonimmune "Fulminant" type 1 diabetes presenting with diabetic ketoacidosis during pregnancy.BACKGROUND: Ketoacidosis in pregnant women with previously undiagnosed diabetes is rare. Although insulin-dependent diabetes has recently been classified as either autoimmune (type 1A) or nonimmune (type 1B; "chronic" and "fulminant" subtypes), the clinical characteristics of diabetes in such settings are not fully understood. CASE: We report two pregnant patients with previously undiagnosed diabetes. They presented with severe diabetic ketoacidosis characterized by an abrupt onset, normal, or slightly elevated level of glycosylated hemoglobin, absence of diabetes-related autoimmune antibodies, and features typical of the "fulminant" subtype of nonimmune diabetes. The fetuses died in utero, and the mothers became insulin dependent. CONCLUSION: The "fulminant" subtype of diabetes may be associated with fetal death.- - - - - - - - - - ranking = 5keywords = ketoacidosis (Clic here for more details about this article) |
3/16. Rhinocerebral mucormycosis in a pregnant woman with diabetic ketoacidosis.Rhinocerebral mucormycosis (RCM) is a rare but often fatal condition characterized by aggressive necrotizing infection originating from nose and spreading to paranasal sinuses, orbit and central nervous system. Although fungi and spores of mucorales show minimal intrinsic pathogenicity towards normal persons, they can initiate fulminant infections in patients with underlying debilitating conditions. A case of RCM in a pregnant woman with diabetic keto-acidosis successfully treated by supportive care, amphotericin b and surgery is reported.- - - - - - - - - - ranking = 4keywords = ketoacidosis (Clic here for more details about this article) |
4/16. diabetic ketoacidosis in pregnancy.The occurrence of diabetic ketoacidosis in pregnancy compromises both the fetus and the mother. It usually occurs in the later stages of pregnancy and is also seen in newly presenting type 1 diabetes patients. Despite improvement in its incidence rates and outcomes over the years, it still remains a major clinical problem since it tends to occur at lower blood glucose levels and more rapidly than in non-pregnant patients often causing delay in the diagnosis. This article illustrates a typical case of diabetic ketoacidosis in pregnancy and reviews the literature to provide an insight into its pathophysiology and management.- - - - - - - - - - ranking = 6keywords = ketoacidosis (Clic here for more details about this article) |
5/16. diabetic ketoacidosis in pregnancy.OBJECTIVE: The development of diabetic ketoacidosis in pregnancy is a medical emergency, requiring treatment in an intensive care setting. Both the mother and the fetus are at risk for significant morbidity and mortality. Physiologic changes unique to pregnancy provide a background for the development of diabetic ketoacidosis. An understanding of these physiologic changes assists in the management of the two patients being treated. Treatment of the patient with diabetic ketoacidosis includes insulin therapy and careful fluid management; recommendations for management are presented. patients: pregnant women, either with preexisting diabetes or with diabetes diagnosed during pregnancy. CONCLUSIONS: Prompt recognition of the clinical manifestations of diabetic ketoacidosis, followed by appropriate, timely treatment will optimize outcome for the pregnant woman and her fetus.- - - - - - - - - - ranking = 8keywords = ketoacidosis (Clic here for more details about this article) |
6/16. Glycemic control with continuous subcutaneous insulin infusion with use of U-500 insulin in a pregnant patient.OBJECTIVE: To demonstrate the benefits and to advocate the safety and efficacy of using an insulin pump with U-500 insulin in comparison with U-100 insulin for a pregnant patient with diabetes requiring massive doses of insulin. methods: We present a detailed case report about the use of continuous subcutaneous insulin infusion with U-500 insulin during pregnancy. Dose calculation is reviewed, and the benefits of insulin pump therapy in patients with diabetes are discussed. RESULTS: A 34-year-old white woman, with a history of type 2 diabetes for 7 years, was seen at 17 weeks of gestation because of episodes of hyperglycemia and hypoglycemia accompanied by a very high insulin requirement. At the time of initial assessment, the patient was hospitalized with diabetic ketoacidosis and was being treated with 400 U/day of intravenously administered insulin. She responded well to intravenous therapy, but when switched to a regimen of NPH and regular insulin, she continued to have high blood glucose levels (despite 4 to 5 insulin injections a day, with a total daily dose up to 400 to 450 U). Use of an insulin pump was instituted, which presented another challenge because of the limited reservoir capacity and the need to change sites at least once or twice a day. We decided to initiate U-500 insulin therapy with a total basal rate of 40 U/day. Her meal carbohydrate insulin ratio and correction bolus were calculated on a U-100 scale. Then each estimated dose for meal coverage, depending on her carbohydrate intake, as well as the appropriate corrections were totaled and divided by 5 to convert to U-500. Throughout the rest of her pregnancy, the patient was able to maintain tight glycemic control, with no further hospitalizations for stabilization of hyperglycemia or hypoglycemia. CONCLUSION: To our knowledge, this is the first report of successful management of difficult to control diabetes by means of an insulin pump with use of U-500 insulin in a pregnant patient who required massive doses of insulin.- - - - - - - - - - ranking = 1keywords = ketoacidosis (Clic here for more details about this article) |
7/16. diabetic ketoacidosis and insulin resistance with subcutaneous terbutaline infusion: a case report.diabetic ketoacidosis may occur in women treated with intravenous beta-sympathomimetic agents for tocolysis. We describe diabetic ketoacidosis and transient severe insulin resistance in a woman with diabetes who was treated with subcutaneous terbutaline infusion. Subcutaneous terbutaline infusion may precipitate transient insulin resistance and diabetic ketoacidosis in women with diabetes.- - - - - - - - - - ranking = 7keywords = ketoacidosis (Clic here for more details about this article) |
8/16. Ketoacidosis in pregnancy associated with the parenteral administration of terbutaline and betamethasone. A case report.diabetic ketoacidosis occurred in a woman without a prior history of glucose intolerance. The condition was associated with the combined administration of terbutaline and betamethasone. The patient required insulin therapy for the remainder of her pregnancy but had no further insulin requirements postpartum.- - - - - - - - - - ranking = 1keywords = ketoacidosis (Clic here for more details about this article) |
9/16. Intravenous ritodrine as a possibly provocative predictive test in gestational diabetes. A case report.A 24-year-old, nonobese, gestational diabetic woman developed diabetic ketoacidosis while receiving intravenous ritodrine therapy to suppress premature labor. This case emphasizes the necessity for close observation of any gestational diabetic during intravenous ritodrine tocolysis and suggests the possibility of predicting diabetes in pregnant patients exhibiting marked glucose intolerance during therapy.- - - - - - - - - - ranking = 1keywords = ketoacidosis (Clic here for more details about this article) |
10/16. Treatment of severe diabetic ketoacidosis in the early third trimester in a patient with fetal distress. A case report.A patient presented with severe diabetic ketoacidosis at 30 weeks' gestation. Her case was complicated by uterine contractions and fetal distress. Treatment with rehydration and continuous infusion of insulin not only reversed the diabetic ketoacidosis but also stopped the uterine contractions and fetal distress. Ketoacidosis can stimulate uterine contractions and cause signs of fetal distress; these problems can be reversed by adequately treating the diabetic ketoacidosis.- - - - - - - - - - ranking = 7keywords = ketoacidosis (Clic here for more details about this article) |
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