Rivas M Margarita, Belmar Z Pamela, Durruty A Pilar, Sanhueza M Lilian, López S Gloria
Sección Endocrinología y Diabetes, Hospital Clínico, Universidad de Chile, Santiago, Chile.
Hospital San Juan de Dios, Hospital San Juan de Dios, Santiago, Chile.
Rev Med Chil. 2016 Oct;144(10):1360-1364. doi: 10.4067/S0034-98872016001000018.
Normoglycemic diabetic ketoacidosis should be suspected in pregnant women presenting nausea, vomiting, abdominal pain and anorexia. We report a 39 years old woman with a 32 weeks pregnancy who sought emergency care due to hyperemesis. She was hospitalized with the following diagnoses: pregnancy hypertension syndrome, gestational diabetes, morbid obesity and poor prenatal control. The evaluation of the feto-placental unit showed perception of fetal movements, non-reactive non-stress baseline record and a biophysical profile of 6/8. Fetal maturation was initiated. Laboratory tests showed a metabolic acidosis, a low pH, an increased Gap anion, elevated ketonemia and a blood glucose of 172 mg/dl. A diagnosis of normoglycemic diabetic ketoacidosis was formulated and treatment with hydration and regular insulin according to capillary blood glucose levels was started. An emergency caesarean section was performed. The newborn weighed 2.650 kg, had a length of 46 cm, was large for gestational age, had an Apgar score of 2.7, had perinatal asphyxia, convulsive syndrome and a possible congenital cardiopathy. Once the ketoacidosis was resolved during the immediate puerperium, slow acting insulin was initiated.
对于出现恶心、呕吐、腹痛和厌食的孕妇，应怀疑存在血糖正常的糖尿病酮症酸中毒。我们报告一名39岁、孕32周的女性，因妊娠剧吐寻求急诊治疗。她因以下诊断住院：妊娠高血压综合征、妊娠期糖尿病、病态肥胖和产前控制不佳。对胎儿-胎盘单位的评估显示可感知胎动、无应激试验基线记录无反应且生物物理评分6/8。开始促进胎儿成熟。实验室检查显示代谢性酸中毒、低pH值、阴离子间隙增加、酮血症升高且血糖为172mg/dl。诊断为血糖正常的糖尿病酮症酸中毒，并开始根据毛细血管血糖水平进行补液和使用正规胰岛素治疗。进行了急诊剖宫产。新生儿体重2.650kg，身长46cm，大于孕周，阿氏评分2.7分，有围产期窒息、惊厥综合征和可能的先天性心脏病。在产褥早期酮症酸中毒得到缓解后，开始使用中效胰岛素。
