Orgovan Jessica M, Sherman Amanda G, Porfeli Erin P, Taskin Berk
Medical School, West Virginia School of Osteopathic Medicine, Lewisburg, USA.
Obstetrics and Gynecology, Mon Health Medical Center, Morgantown, USA.
Cureus. 2025 Jul 7;17(7):e87474. doi: 10.7759/cureus.87474. eCollection 2025 Jul.
Hyperemesis gravidarum and diabetic ketoacidosis (DKA) can be difficult to distinguish in pregnant patients, as both conditions present with nausea, vomiting, and elevated ketones. Although uncommon, there should be a high index of suspicion for DKA in pregnant patients who exhibit these symptoms, given the potential for life-threatening maternal and fetal outcomes. Here we present a rare case of covert DKA in the first trimester of pregnancy that was initially diagnosed and treated as hyperemesis gravidarum due to the absence of a wide anion gap, which tragically resulted in fetal demise. The patient was admitted to the intensive care unit (ICU) and hospitalized for over a week but was eventually discharged in stable condition with a favorable prognosis. This report aims to contribute to clinical awareness of this metabolic complication and to emphasize the importance of prevention, early recognition, and timely management of DKA in pregnancy, along with vigilant fetal monitoring in diabetic patients.
妊娠剧吐和糖尿病酮症酸中毒（DKA）在孕妇中可能难以区分，因为这两种情况都表现为恶心、呕吐和酮体升高。虽然不常见，但对于出现这些症状的孕妇，应高度怀疑DKA，因为其可能导致危及母婴生命的后果。在此，我们报告一例罕见的妊娠早期隐匿性DKA病例，该病例最初因未出现明显的阴离子间隙而被诊断为妊娠剧吐并接受治疗，不幸的是最终导致胎儿死亡。患者被收入重症监护病房（ICU）并住院一周多，但最终出院时病情稳定，预后良好。本报告旨在提高对这种代谢并发症的临床认识，并强调预防、早期识别和及时处理妊娠期DKA的重要性，以及对糖尿病患者进行密切胎儿监测的重要性。
