Complexities in Pregnancy: Diabetic Ketoacidosis Initially Thought to Be Hyperemesis Gravidarum Resulting in Early Fetal Demise.

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.