Diabetic ketoacidosis in pregnancy – Case series, pathophysiology, and review of the literature

Eshkoli, Tamar; Barski, Leonid; Faingelernt, Yaniv; Jotkowitz, Alan; Finkel-Oron, Alona; Schwarzfuchs, Dan

doi:10.1016/j.ejogrb.2021.12.011

Cited by 17 publications

(24 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The maternal and fetal outcomes reported in previously published retrospective studies and case series of DKA in pregnancy are outlined in Table 1. 7,14,24,29,[46][47][48][49][50][51] . Original studies were chosen through literature search in the PubMed database using combinations of the following key search terms: "diabetes", "gestational diabetes", "GDM", "Type 2 diabetes", "hyperglycemia", "ketoacidosis", "pregnancy".…”

Section: What Are the Outcomes Following Diabetic Ketoacidosis In Pre...mentioning

confidence: 99%

Diabetic Ketoacidosis in Pregnancy: An Overview of Pathophysiology, Management, and Pregnancy Outcomes

2022

View full text Add to dashboard Cite

Diabetic ketoacidosis (DKA) is an obstetrical emergency that is associated with an elevated risk of adverse pregnancy outcomes. This includes pregnancy loss in up to 1 in 3 cases. Due to the normal metabolic changes that occur during pregnancy, females who are pregnant are more vulnerable to DKA, and it can occur at lesser than expected degrees of hyperglycaemia. Presenting symptoms can be non-specific and include nausea and vomiting, fatigue, polydipsia, and polyuria. DKA may be the first presentation of previously undiagnosed diabetes. Therefore, high index of suspicion, along with prompt diagnosis and management, is essential. The cornerstones of management include intravenous insulin, intravenous fluids, and electrolyte replacement. Treatment generally follows the principles for DKA management outside of pregnancy, with some additional considerations. Close maternal and fetal monitoring is essential, and intensive care unit admission is typically required to adequately achieve this goal. In all situations, a thorough investigation should occur to address the underlying cause of the DKA and prevent further episodes. This review article outlines the potential etiopathogenesis, clinical presentation, and management of DKA in pregnancy.

show abstract

Section: What Are the Outcomes Following Diabetic Ketoacidosis In Pre...mentioning

confidence: 99%

Diabetic Ketoacidosis in Pregnancy: An Overview of Pathophysiology, Management, and Pregnancy Outcomes

2022

View full text Add to dashboard Cite

show abstract

“…Patients become dependent on insulin as a result of this, and the lack of natural insulin makes patients vulnerable to DKA. On the other hand, type 2 diabetes differs from type 1 diabetes because it is caused by insulin resistance in the body in elderly patients, which leads to beta-cell burnout over time[ 5 ]. KPD is a type 2 diabetes-like illness that involves DKA but occurs later in life and can regain beta cell activity, similar to type 2 diabetes.…”

Section: Background and History Of Kpdmentioning

confidence: 99%

“…KPD is a type 2 diabetes-like illness that involves DKA but occurs later in life and can regain beta cell activity, similar to type 2 diabetes. KPD has similar biochemical and acid-base parameters to type 1 diabetes[ 5 ].…”

Section: Background and History Of Kpdmentioning

confidence: 99%

“…Furthermore, increased alveolar ventilation in the mother results in respiratory alkalosis that is offset by increased bicarbonate secretion which can lead to ketoacidosis. Additionally, the fetus uses a significant amount of maternal glucose, which leads to decreased fasting glucose of the mother, which in relation to the insulin deficiency leads to increased production of free fatty acids that are converted to ketones in the liver[ 5 ].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Ketosis-prone diabetes mellitus: A phenotype that hospitalists need to understand

Boike¹,

Mir²,

Rauf³

et al. 2022

World J Clin Cases

View full text Add to dashboard Cite

Diabetes has been classified mainly into types 1 and 2. Some type 2 diabetes patients, when developing ketosis, have been labeled as having atypical diabetes. Lately, syndromes of ketosis-prone diabetes, primarily in patients who we previously classified as type 2 diabetics, have emerged, and calls are being made to even reclassify diabetes. This mini-review will extensively deal with the historical, molecular, phenotypical, and clinical basis of why ketosis-prone diabetes is different than the traditional principles of type 1 and 2 diabetes and should be classified as such. Clinicians, especially those who are not diabetologists or endocrinologists, as well as hospitalists, intensivists, and primary care providers, will greatly benefit from this review.

show abstract

“…Pregnancy is a physiologic state of hypoinsulinemia and the human lactogen hormone produced during pregnancy causes insulin resistance, vomiting, and starvation resulting in ketogenesis, in addition to that respiratory alkalosis, which is also common in pregnancy due to stimulation of the respiratory center by progesterone, which results in bicarbonate excretion and acidosis develops [ 5 ]. It is important to note that the fetus and placenta use large amounts of maternal glucose as a major source of energy, and this leads to decreased maternal fasting glucose [ 9 ]. Hence, pregnancy is an important precipitating factor for euglycemic DKA.…”

Section: Introductionmentioning

confidence: 99%

A Literature Review of the Therapeutic Perspectives of Sodium-Glucose Cotransporter-2 (SGLT2) Inhibitor-Induced Euglycemic Diabetic Ketoacidosis

Patel¹,

Nair²

2022

Cureus

View full text Add to dashboard Cite

Euglycemic diabetic ketoacidosis (DKA), a side effect of sodium-glucose cotransporter-2 (SGLT2) inhibitors, is a triad of high metabolic anion gap acidosis, raised serum and urine ketones, and serum glucose <250 mg/dl. SGLT2 inhibitors cause a carbohydrate deficit by glucosuria, which leads to an increased glucagon/insulin ratio, the metabolic shift from glucose to lipid utilization causing ketogenesis, and hence euglycemic DKA. Additional factors like the ketogenic diet, illness, surgery, and pregnancy contribute to precipitating these episodes.Keywords search included "Euglycemic DKA and SGLT2 inhibitors" in PubMed and Google Scholar, to compile data from existing articles that provide information on the withholding and restarting period of the drug after a euglycemic DKA episode. SGLT2 inhibitors, used in the treatment of type 2 DM, have an average half-life of 11-13 hours, so most articles suggested withholding the drug three days before any elective surgery but some articles suggested a longer withholding period based on other precipitating factors contributing to euglycemic DKA. Hence, we came up with patient inclusion criteria and concomitant therapies review that we need to consider in making this decision. In addition, a multidisciplinary approach is required when laying out guidelines for restarting the drug to have a unanimous approach.After reviewing the existing literature, it is clear that concrete guidelines are required to decide on drug withholding and restarting periods after a euglycemic DKA episode, as they vary among different institutions and different specialties. We believe it is crucial to consider patient inclusion criteria and concomitant therapies in forming those guidelines.

show abstract

Diabetic ketoacidosis in pregnancy – Case series, pathophysiology, and review of the literature

Cited by 17 publications

References 23 publications

Diabetic Ketoacidosis in Pregnancy: An Overview of Pathophysiology, Management, and Pregnancy Outcomes

Diabetic Ketoacidosis in Pregnancy: An Overview of Pathophysiology, Management, and Pregnancy Outcomes

Ketosis-prone diabetes mellitus: A phenotype that hospitalists need to understand

A Literature Review of the Therapeutic Perspectives of Sodium-Glucose Cotransporter-2 (SGLT2) Inhibitor-Induced Euglycemic Diabetic Ketoacidosis

Contact Info

Product

Resources

About