Gestational diabetes presenting as diabetic ketoacidosis

Diabetic Ketoacidosis (DKA) is a rare complication of diabetic pregnancy and usually associated with underlying Type 1 diabetes.1 It is an extremely rare complication of gestational diabetes.2 – 3 and also recognised that type 1 diabetes can present in pregnancy as DKA.4 The metabolic changes that accompany pregnancy predispose to ketosis are, an insulin antagonistic state, accelerated starvation, emesis and lowered buffering capacity.5 The use of corticosteroids,6 -agonists and high incidence of urinary tract infection have also been shown to precipitate DKA in pregnancy.5 A previously healthy 23 year old gravida 2, para 1 Caucasian lady presented at 28 weeks gestation feeling generally unwell. She had been suffering from lethargy, had been vomiting for two weeks. In her previous pregnancy she was diagnosed with gestational diabetes. This pregnancy she had an oral glucose tolerance test at 17 weeks gestation, which was normal. She had no risk factors for diabetes, no family history of diabetes and normal body mass index. On examination she was afebrile, heart rate, blood pressure, oxygen saturations and respiratory rate were normal. Urinalysis revealed glycosuria and ketonuria. A random blood sugar measurement was 18.7 mmol/l and arterial blood gases showed a compensated metabolic acidosis. DKA was diagnosed and. immediate resuscitation was started as per the DKA protocol. There was no precipitating cause found. She had no growth on urine or blood cultures and a normal white cell count (10.8). DKA should be considered in pregnant women presenting unwell with ketonuria and treated promptly.