Euglycemic Diabetic Ketoacidosis in Pregnancy

Diabetic ketoacidosis in pregnancy is a rare but serious complication caused by insulin deficiency. Hyperglycemia is considered a hallmark sign of diabetic ketoacidosis; however, physiologic changes of pregnancy predispose pregnant women to developing euglycemic diabetic ketoacidosis, where the plasma glucose level is normal or near normal. Euglycemic diabetic ketoacidosis during pregnancy poses many challenges to diagnosis including signs and symptoms that can be attributed to pregnancy, rapid progression of signs and symptoms, and near-normal glucose levels. Fetal acidosis also develops as a result of the maternal disease process. The fetal heart rate tracing in diabetic ketoacidosis often features minimal to absent variability, fetal tachycardia, or recurrent or late decelerations. Treatment should focus on correcting maternal acidosis and electrolyte imbalances. Despite the state of the fetal heart rate tracing, birth is not typically indicated as fetal status should improve over time after correcting maternal acidosis. To improve outcomes and prevent worsening complications, early diagnosis and intervention is vital for patients with diabetic ketoacidosis. A collaborative, multidisciplinary approach to these patients can facilitate timely diagnosis and initiation of treatment. We present a case study of a patient diagnosed with euglycemic diabetic ketoacidosis secondary to influenza A that required emergency cesarean birth due to worsening maternal and fetal status despite corrective interventions.