Diabetic ketoacidosis.

Diabetic ketoacidosis (DKA) is a form of decompensated diabetes. When it occurs during pregnancy, it may lead to maternal and fetal morbidity and mortality. DKA is defined by accelerated gluconeogenesis and ketogenesis and occurs most often in the presence of one of four predisposing factors: insulin deficiency (absolute or relative); excess counter regulatory hormones; fasting; and dehydration. Infection is a common catalyst. Once the disorder is diagnosed, intensive obstetrical nursing care is required. The principles of management include rehydration, insulin therapy, electrolyte replacement, and identification and treatment of the underlying cause. A plan for assessment of the pregnant patient with diabetes and in DKA and treatment guidelines are presented.