Euglycemic Diabetic Ketoacidosis in a Young Pregnant Woman Precipitated by Urinary Tract Infection

Muppidi, Vijayadershan; Meegada, Sreenath; Challa, Tejo; Siddamreddy, Suman; Samal, Subhankar

doi:10.7759/cureus.7331

Cited by 2 publications

(3 citation statements)

References 20 publications

(25 reference statements)

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“…Muppidi et al reported a young pregnant woman with T1DM presenting with urinary tract infection symptoms, causing nausea and vomiting in her third trimester of pregnancy [ 41 ]. Her blood glucose was <200 mg/dL with ketosis and metabolic acidosis.…”

Section: Reviewmentioning

confidence: 99%

Euglycemic Diabetic Ketoacidosis and Sodium-Glucose Cotransporter-2 Inhibitors: A Focused Review of Pathophysiology, Risk Factors, and Triggers

Somagutta¹,

Agadi²,

Hange³

et al. 2021

Cureus

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Diabetic ketoacidosis (DKA) is an acute and significant life-threatening complication of diabetes. The association of sodium-glucose cotransporter-2 inhibitors (SGLT2i) with euglycemic diabetic ketoacidosis (EDKA) has been well reported. This literature review was conducted to understand the mechanism of EDKA and identify the potential risk factors and precipitants for patients taking SGLT2i. After reviewing the published literature between 2010 and 2020, 32 articles are included in the final review. The underlying mechanism is mainly enhanced lipolysis and ketone body reabsorption. SGLT2i also stimulates pancreatic alpha cells and inhibits beta cells, causing an imbalance in glucagon/insulin levels, further contributing to lipolysis and ketogenesis. Most patients were diagnosed with blood glucose less than 200 mg/dL, blood pH <7.3, increased anion gap, increased blood, or urine ketones. Perioperative fasting, pancreatic etiology, low carbohydrate or ketogenic diet, obesity, and malignancy are identified precipitants in this review. As normoglycemia can conceal the underlying acidosis, physicians should be cognizant of the EDKA diagnosis and initiate prompt treatment. Patient education on risk factors and triggers is recommended to avoid future events.

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Section: Reviewmentioning

confidence: 99%

Euglycemic Diabetic Ketoacidosis and Sodium-Glucose Cotransporter-2 Inhibitors: A Focused Review of Pathophysiology, Risk Factors, and Triggers

Somagutta¹,

Agadi²,

Hange³

et al. 2021

Cureus

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show abstract

“…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.…”

mentioning

confidence: 99%

“… 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 …”

mentioning

confidence: 99%

Euglycemic diabetic ketoacidosis and COVID‐19: A combination to foresee in pregnancy

Velasco

Soldevila

Julián

et al. 2021

Journal of Diabetes

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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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Euglycemic Diabetic Ketoacidosis in a Young Pregnant Woman Precipitated by Urinary Tract Infection

Cited by 2 publications

References 20 publications

Euglycemic Diabetic Ketoacidosis and Sodium-Glucose Cotransporter-2 Inhibitors: A Focused Review of Pathophysiology, Risk Factors, and Triggers

Euglycemic Diabetic Ketoacidosis and Sodium-Glucose Cotransporter-2 Inhibitors: A Focused Review of Pathophysiology, Risk Factors, and Triggers

Euglycemic diabetic ketoacidosis and COVID‐19: A combination to foresee in pregnancy

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