Stress-Induced Transient Diabetic Ketoacidosis (DKA) in Pregnancy Without Pre-existing Diabetes

Diabetic ketoacidosis (DKA) is a rare condition that can result in adverse maternal and foetal outcomes. Recognising atypical presentations such as euglycaemic or starvation ketoacidosis is crucial, as delayed diagnosis can be fatal. We report the case of a pregnant woman under 20 weeks' gestation who presented with vomiting, dehydration, and metabolic acidosis. Laboratory findings revealed significant ketonaemia and acidaemia, with only transient hyperglycaemia lasting less than 24 hours. Her HbA1c was normal, diabetes antibodies were negative, and glucose monitoring remained normal throughout hospitalisation and subsequent follow-up, confirming the absence of underlying latent diabetes. The episode was likely precipitated by infection, dehydration, and starvation. Pregnancy amplifies the metabolic response to stress and starvation, lowering the threshold for ketone production. This case highlights the diagnostic challenge of recognising DKA physiology in non-diabetic pregnant patients.