title: The changing presentations of diabetic ketoacidosis during pregnancy.
abstract: The purpose of the present study was to examine the presentation and outcomes associated with diabetic ketoacidosis (DKA) in pregnancies complicated by diabetes. Eleven episodes (2%) of DKA were diagnosed during the 10-year study period. All patients were under close observation by the Diabetes-in-Pregnancy Service. Plasma glucose levels of less than 200 mg/dL were present in 4 of the 11 patients (36%), 10 (90%) of whom presented with nausea, vomiting, and decreased caloric intake. Two subsequently had fetal distress necessitating cesarean section. One fetal death occurred in a patient treated with subcutaneous insulin. Despite contemporary methods of diabetes care, near-normal plasma glucose levels are not enough to preclude diabetic ketoacidosis. Nausea, vomiting, and decreased caloric intake in an otherwise normal pregnant, diabetic woman requires evaluation to exclude ketosis.
authors.affiliation: Department of Obstetrics and Gynecology at Yale University School of Medicine, New Haven, Connecticut, USA.
authors.forename: M T
authors.initials: MT
authors.lastname: Cullen
authors.forename: E A
authors.initials: EA
authors.lastname: Reece
authors.forename: C J
authors.initials: CJ
authors.lastname: Homko
authors.forename: E
authors.initials: E
authors.lastname: Sivan
mesh_terms: D016640:Diabetes, Gestational / Q000150:complications*; D016883:Diabetic Ketoacidosis / Q000175:diagnosis* / Q000188:drug therapy; D005260:Female; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D011247:Pregnancy; D011254:Pregnancy in Diabetics
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin