|
Diabetic Ketoacidosis (DKA)
DKA is condition that occurs in diabetics due to lack of insulin. Lack of
insulin leads to hyperglycemia and hyperketonemia
with production of acetoacetic acid
and β-hydroxybutyric acid that create metabolic acidosis. Hyperglycemia causes
osmotic diuresis which leads to severe dehydration.
Signs and symptoms may include nausea, vomiting, abdominal pain, thirst,
excessive urine output, dehydration with tachycardia and hypotension. Breathing
may be deep and rapid ( Kussmaul repirations). The patient's breath may
smell "fruity" due to exhaled acetone.
Without treatment DKA progresses to coma and
death.
Diagnostic Criteria for Diabetic Ketoacidosis [1]
Plasma glucose >250 mg/dL* , arterial pH <7.3 , and positive serum and/or urine
ketones (especially 3β-hydroxybutyrate)
| Severity |
Arterial
pH |
Serum
bicarbonate (mEq/L) |
Mental
status |
| Mild |
7.25-7.30
|
15-18 |
alert
|
| Moderate |
7 - 7.24 |
10 to <15 |
drowsy |
| Severe |
<7
|
<10
|
stupor/
coma |
* DKA may occur with relatively low blood sugar
levels during pregnancy
Precipitating Factors for Diabetic Ketoacidosis in
Pregnancy [2]
Protracted vomiting, starvation , use of β-sympathomimetic agents for
tocolysis, infection, new-onset diabetes ,poor control of blood sugars or
poor compliance with treatment , insulin pump failure ,steroid use for
fetal lung maturation or chronic medical disorder
REFERENCES
1. Kitabchi AE, et al., Hyperglycemic crises in adult patients with diabetes.
Diabetes Care. 2009 Jul;32(7):1335-43. doi: 10.2337/dc09-9032.
PMID: 19564476
http://care.diabetesjournals.org/content/32/7/1335.long
2.
Diabetic ketoacidosis in pregnancy. Sibai BM, Viteri OA.Obstet Gynecol.
2014 Jan;123(1):167-78. doi: 10.1097/AOG.0000000000000060. PMID: 24463678
3.
Guo RX, et. al., Diabetic ketoacidosis in pregnancy tends to occur at lower
blood glucose levels: case-control study and a case report of euglycemic
diabetic ketoacidosis in pregnancy. J Obstet Gynaecol Res. 2008
Jun;34(3):324-30. doi: 10.1111/j.1447-0756.2008.00720.x.PMID: 18588610
4. Chico M, et. al., Normoglycemic diabetic ketoacidosis in pregnancy. J
Perinatol. 2008 Apr;28(4):310-2. doi: 10.1038/sj.jp.7211921. PMID: 18379571
5. Tarif N, Al Badr W. Euglycemic diabetic ketoacidosis in pregnancy. Saudi J
Kidney Dis Transpl. 2007 Nov;18(4):590-3. PMID: 17951948
6. Himuro H, et al., A case of a woman with late-pregnancy-onset DKA who had
normal glucose tolerance in the first trimester. Endocrinol Diabetes Metab Case
Rep. 2014;2014:130085. doi: 10.1530/EDM-13-0085. Epub 2014 Apr 1. PMID:
24711923
7. Maislos M, et al., Diabetic ketoacidosis. A rare complication of
gestational diabetes. Diabetes Care. 1992 Aug;15(8):968-70. PMID: 1505328
|
|
|
|
