Insulin-requiring pregnant women, and the undiagnosed pregestational diabetic, may experience diabetic ketoacidosis (DKA) at glucose levels far below those usually associated with this complication. The insulin resistance that develops as pregnancy progresses may trigger ketoacidosis.
Polydipsia, polyuria, dehydration and nausea/vomiting can be early signs of DKA.
Diagnosis
- Low serum bicarbonate
- Arterial blood gas showing metabolic acidosis
- Elevated blood glucose, even as low as 200 mg/dl
- Serum and urinary ketones
Treatment
- Correction of hypovolemia with normal saline - one liter in first hour, then total of 4 to 6 liters in the first 12 hours
- Intravenous low-dose insulin: 0.2 to 0.3 units/kg loading dose, and 2 to 10 units per hour
- Frequent measurement of blood glucose, serum potassium, bicarbonate, and serum acetone
- Add 5% dextrose to normal saline when glucose levels fall to 200 - 250 mg/dl
- Potassium levels are increased initially, even in the face of decreased total body potassium. When insulin treatment causes elevated potassium to begin to fall, add potassium 20-30 mEq per liter to infusion.
- Continuous fetal monitoring is essential during treatment