(646) Onset of DKA During Delivery in a Pregnant Patient With Normal Glucose Tolerance Prior to Childbirth

Introduction: Although rare, diabetic ketoacidosis (DKA) is a life-threatening condition that can affect patients with gestational diabetes. It is estimated to occur in 1-2% of pregnant patients with impaired glucose tolerance and can result in maternal and fetal mortality. DKA occurs when the body is deficit in insulin and unable to properly utilize glucose for energy. As a result, the body breaks down fat for energy which results in the production and release of ketones, causing acidosis.

Description: We report the case of a 28-year-old pregnant female (35 weeks 2days) who presents to the hospital with nausea, vomiting and contractions. The patient had no prior history of diabetes, an A1c of 5.1% at the time of admission and no recent diet or medication changes. The glucose tolerance test 6 weeks prior to delivery was normal. She was taken to the OR for emergent C-section and found to have severe hyperglycemia and profound metabolic acidosis. The delivery was successful, and the patient was transferred to the ICU for management of DKA. Initial labs showed a glucose of 398 mg/dl, anion gap of 23.9 mMol/L, pH of 6.93 and betahydroxybutyrate of 6.44 mMol/L. An Anti-GAD antibody test was sent to rule out Type 1 DM which was subsequently found to be negative. After stabilization in the ICU, the patient was successfully transitioned to the floor and discharged from the hospital.

Discussion: Common precipitating factors for DKA in pregnancy are infection, insulin therapy failure/non-adherence, and steroid use for fetal lung maturity in the setting of premature onset of labor. However, none of these factors were present in our patient. The onset of DKA in a pregnant patient with no prior history of diabetes, a normal A1c and a normal fasting glucose tolerance test 6 weeks prior to delivery is extremely rare. Upon review of the literature, we found only one other case describing the onset of late pregnancy onset DKA in a patient with a normal glucose tolerance test in the first trimester. Although new onset DKA in pregnant patients is extremely rare, it is an endocrine emergency that that put both the patient and fetus at risk. This case highlights the need for early recognition and prompt obstetrical and ICU care for successful outcomes.