[Euglycemic ketoacidosis in gestational diabetes]
Mette Toftager1, Louise Kelstrup1,2, Elisabeth R Mathiesen3
1Afdeling for Kvindesygdomme, Graviditet og Fødsler, Københavns Universitetshospital - Herlev Hospital.
Ugeskrift for Laeger
|July 3, 2026
Summary
A pregnant woman with gestational diabetes developed severe euglycemic ketoacidosis (DKA) after betamethasone treatment. Prompt intensive care management led to full maternal recovery and a healthy term pregnancy.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
- Endocrinology
Background:
- Gestational diabetes and hyperemesis are common pregnancy complications.
- Betamethasone is used to manage threatened preterm labor.
- Euglycemic diabetic ketoacidosis (DKA) is a rare but serious condition.
Purpose of the Study:
- To report a case of severe euglycemic DKA in pregnancy.
- To highlight the importance of prompt recognition and management of this condition.
Main Methods:
- Case report of a pregnant patient with diet-controlled gestational diabetes and hyperemesis.
- Administration of betamethasone for threatened preterm labor.
- Diagnosis of severe euglycemic DKA via arterial blood gas analysis and ketone levels.
Main Results:
- The patient developed severe euglycemic DKA, characterized by metabolic acidosis, elevated ketones, and normal blood glucose levels.
- Intensive care management using a modified pregnancy-adapted protocol was initiated.
- Complete maternal recovery and progression to a term delivery were achieved.
Conclusions:
- Euglycemic DKA in pregnancy, though uncommon, is a critical condition requiring immediate medical attention.
- Effective management involves prompt diagnosis and tailored intensive care.
- This case underscores the need for awareness among healthcare providers regarding this potential complication.
Related Concept Videos
01:25Diabetic Ketoacidosis l: Introduction
DefinitionDiabetic ketoacidosis (DKA) is an acute, life-threatening complication of diabetes mellitus, characterized by a triad of hyperglycemia (blood glucose >250 mg/dL), ketonemia or ketonuria, and metabolic acidosis (arterial pH <7.30 and serum bicarbonate <18 mEq/L). It results from insulin deficiency combined with elevated levels of counterregulatory hormones—glucagon, catecholamines, cortisol, and growth hormone—leading to increased lipolysis, hepatic ketone production, and...
01:22Diabetic Ketoacidosis ll: Pathophysiology
Diabetic ketoacidosis (DKA) is a metabolic emergency characterized by hyperglycemia, ketonemia, and metabolic acidosis. It results from severe insulin deficiency and an excess of counterregulatory hormones, leading to uncontrolled lipolysis, ketogenesis, and widespread electrolyte and fluid disturbances.Pathophysiology The central event in DKA is a profound loss of insulin action. Without insulin, glucose uptake in insulin-dependent tissues is impaired, while hepatic glucose production...
01:22Diabetes Mellitus: Type 2 and Gestational
Type 2 diabetes, characterized by insulin resistance, arises when the insulin receptors on cells lose responsiveness to insulin, diminishing the cell's capacity to take up glucose, resulting in elevated blood glucose levels. To receive a diagnosis of Type 2 diabetes, a series of blood glucose tests are necessary to assess whether the blood glucose falls within normal parameters. If the result is out of the normal range, a patient may be diagnosed as prediabetic or diabetic, depending on the...
01:20Pathophysiology of Diabetes
Diabetes mellitus is a chronic metabolic disorder characterized by hyperglycemia. The four categories of diabetes are type 1 diabetes, type 2 diabetes, other specific types of diabetes, and gestational diabetes.
Type 1 diabetes is characterized by autoimmune-mediated destruction of pancreatic β cells, with environmental factors potentially triggering this process in genetically susceptible individuals. Despite many not having a family history, certain genes increase susceptibility, suggesting a...
Type 1 diabetes is characterized by autoimmune-mediated destruction of pancreatic β cells, with environmental factors potentially triggering this process in genetically susceptible individuals. Despite many not having a family history, certain genes increase susceptibility, suggesting a...
01:29Hyperglycemia
Hyperglycemia is an abnormally high blood glucose level. It is diagnosed by fasting glucose ≥126 mg/dL, 2-hour oral glucose tolerance test (or OGTT) ≥200 mg/dL, random glucose ≥200 mg/dL with symptoms, or HbA1c ≥6.5%. However, HbA1c results may be unreliable in certain conditions, such as anemia or hemoglobinopathies, and the diagnosis should be confirmed unless classic symptoms are present. Postprandial hyperglycemia is typically considered significant when glucose levels exceed 180 mg/dL two...
01:21Hyperosmolar Hyperglycemic State
Hyperosmolar Hyperglycemic State, or HHS, is a serious and life-threatening complication of type 2 diabetes mellitus. It is characterized by three main features: severe hyperglycemia, profound dehydration, and elevated serum osmolality, all occurring without significant ketoacidosis.HHS typically develops in older adults or individuals with limited access to fluids. This may result from illness, cognitive impairment, or medications such as diuretics or corticosteroids. These factors reduce...