Algaly Gufran, Abdelrahman Amro, Ahmed Sara M I
Department of Emergency Medicine Hamad Medical Corporation Doha Qatar.
Medical Education Hamad Medical Corporation Doha Qatar.
J Am Coll Emerg Physicians Open. 2023 Dec 19;4(6):e13089. doi: 10.1002/emp2.13089. eCollection 2023 Dec.
Euglycemic diabetic ketoacidosis (EDKA) carries serious risks for mortality and morbidity for both the mother and the baby, and it is essential to recognize it early and start immediate treatment.
We present a case of EDKA in a 28-week pregnant woman known to have type 1 diabetes. She was found to have severe acidosis with a blood sugar level of 10.6 mmol/L (190.8 mg/dL) and normal anion gap. She was found to have EDKA, which was confirmed later with a depressed venous pH and bicarbonate level and an increased serum ketone level. The patient's acidosis was not improving significantly with 0.05 units/kg/h of insulin infusion, so a full dose of 0.1 unit/kg/h of insulin infusion was started following a full diabetic ketoacidosis (DKA) protocol regardless of her blood sugar level. The patient showed gradual improvement and was discharged home after 4 days, with follow-up with endocrinology and obstetrics.
In conclusion, EDKA is a critical complication of diabetes, especially in pregnant women. Therefore, it is crucial to treat it early and potentially consider following a full DKA protocol using 0.1 unit/kg/h insulin infusion instead of 0.05 unit/kg/h.
正常血糖性糖尿病酮症酸中毒（EDKA）对母亲和胎儿均有严重的死亡和发病风险，早期识别并立即开始治疗至关重要。
我们报告一例28周妊娠的1型糖尿病孕妇发生EDKA的病例。她被发现有严重酸中毒，血糖水平为10.6 mmol/L（190.8 mg/dL），阴离子间隙正常。她被诊断为EDKA，后来通过静脉血pH值降低、碳酸氢盐水平降低和血清酮水平升高得以证实。患者在以0.05单位/千克/小时的速度输注胰岛素时酸中毒改善不明显，因此按照完整的糖尿病酮症酸中毒（DKA）方案，无论其血糖水平如何，开始以0.1单位/千克/小时的全剂量输注胰岛素。患者病情逐渐好转，4天后出院，后续由内分泌科和产科进行随访。
总之，EDKA是糖尿病的一种严重并发症，尤其是在孕妇中。因此，早期治疗并可能考虑按照完整的DKA方案使用0.1单位/千克/小时的胰岛素输注而非0.05单位/千克/小时的胰岛素输注至关重要。
