Diabetic ketoacidosis (DKA) is a serious complication of diabetes, becoming a life-threatening event to both the mother and the fetus. 1 Euglycemic diabetic ketoacidosis (eu-DKA) is defined by a biochemical triad: blood glucose levels below 200 mg/dL, increased anion gap metabolic acidosis, and ketonemia. 2,3 Eu-DKA is extremely rare in obstetric practice [4][5][6] and requires a high degree of suspicion for diagnosis. 7 COVID-19 infection may cause ketosis or ketoacidosis in the general population and can also induce DKA for those with diabetes. 8 Diabetes does not seem to increase the risk of COVID-19 occurring but is more frequent in patients with severe COVID-19. 9 Very few cases of eu-DKA have been reported in pregnant women with COVID-19. 10 We present the case of a 29-year-old woman who is obese (BMI 31.5 kg/m 2 ), with gestational diabetes diagnosed at 27 weeks of gestation (initial glycosylated hemoglobin [HbA1c] 5.9%) and suboptimal metabolic control. Weight gain of 20 kg occurred during pregnancy. She was admitted at 34 weeks of gestation due to bilateral COVID-19 pneumonia and metabolic ketoacidosis, a plasma glycemia of 9.4 mmol/L. The analysis highlights a mild normochromic normocytic anemia, leukopenia, plateletopenia with D-dimer elevation; and elevation of inflammatory parameters (polymerase chain reaction 69.7 mg, interleukin-6 65.6 pg/mL, lactate dehydrogenase 780 UI/L) and worsening metabolic rate with HbA1c 7.2%. The patient reported a decrease in intake the previous days.She was treated with oxygen therapy, remdesivir, and enoxaparin for COVID-19 pneumonia. Serum therapy, bicarbonate, and endovenous insulin perfusion were administered for DKA. Eu-DKA was resolved, but glycemic control was difficult with a daily requirement of 300 IU of insulin, maintaining hyperglycemia (capillary glycemic controls 6.6-11 mmol/L).Once the patient seroconverted (immunoglobulin G [IgG] for SARS-CoV-2 became positive), the insulin
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