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Diabetic Ketoacidosis


Learning Objectives

  • Identify risk factors for diabetic ketoacidosis in pregnancy.

  • Recognize presentation of diabetic ketoacidosis in pregnancy.

  • Describe management algorithm for diabetic ketoacidosis in pregnancy.

Diabetic ketoacidosis (DKA) is a relatively rare but life-threatening condition. Pregnant women are prone to develop more severe and more rapidly progressive episodes of DKA at lower glucose levels than nonpregnant women. In pregnancy, there is a particularly increased susceptibility to starvation, infection, and ketogenic factors .

Fig. 22.1
Signs and symptoms of diabetic ketoacidosis.

Fig. 22.2
Management of diabetic ketoacidosis (Modified from ).

Fig. 22.3
(A) During acute diabetic ketoacidosis, fetal decelerations are common. (B) After resuscitation, the fetal heart rate tracing usually becomes reassuring.

Technical and nontechnical skills for management of diabetic ketoacidosis.

Risk Factors

  • Vomiting

  • Starvation

  • Infections (urinary tract, respiratory tract, chorioamniotic infections, skin infections, dental infections, ENT infections, etc.)

  • Poorly controlled glycemia (including noncompliance, insulin pump failure)

  • Beta agonist use

  • Steroid use

  • Diabetic gastroparesis

Diagnosis

  • The signs and symptoms of diabetic ketoacidosis during pregnancy tend to develop faster than in the nonpregnant state. Signs and symptoms include the following (Fig. 22.1) :

    • Hyperventilation/tachypnea or “Kussmaul respirations”

    • Tachycardia

    • Hypotension

    • Dehydration

    • Mental status changes with disorientation or coma

    • Abnormal fetal heart tracing

    • Polyuria or polydipsia

    • Nausea or vomiting

    • Abdominal pain or contractions

      Diabetic Ketoacidosis Simulation

      Materials Needed

      • Volunteer to act as standardized patient

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