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Clinical Management of Diabetic Ketoacidosis in Pregnancy: A Review of Current Literature

DOI: 10.4236/oalib.1112246, PP. 1-25

Subject Areas: Diabetes & Endocrinology, Emergency & Critical Care

Keywords: Management, Diabetes, Diabetic Ketoacidosis, Pregnancy

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Abstract

Background: Diabetic ketoacidosis (DKA) in pregnancy is a life-threatening condition for both the mother and the fetus. This condition is often associated with type 1 diabetes, but it can also complicate type 2 diabetes and rarely complicates gestational diabetes. DKA in pregnancy often occurs in the 3rd trimester of pregnancy and its prevalence is worryingly increasing. Timely diagnosis and appropriate management of DKA are crucial to decreasing the maternal-fetal complications associated with that condition. As DKA in pregnancy is still poorly understood, it is important to increase awareness of healthcare professionals on this condition for its quick diagnosis and appropriate management. This narrative overview aimed to highlight the cornerstones of the management of DKA in pregnancy. Objective: The objective of this research was to review and report the current literature on the management of DKA in pregnancy. Methods: A search of the literature on the management of DKA in pregnancy was conducted through PubMed, Google Scholar, and HINARI. This narrative overview included only abstracts and articles written in English, and published between January 2003 and January 2023. This study focused on the review of the general measures, the use of fluids, the use of electrolytes, and the use of insulin in the management of DKA in pregnancy. Results: Appropriate management of pregnant women with DKA should include their admission to high dependency unit, IV fluids, electrolyte replacement, insulin therapy, management of precipitating factors, and monitoring of maternal-fetal response to treatment. Supplemental oxygen and bicarbonate may be indicated and placement of the pregnant patient in the left lateral position is crucial to avoid aortocaval compression. Conclusions: The timely diagnosis of DKA in pregnancy requires a high index of suspicion of that condition. Appropriate management of DKA in pregnancy includes fluid replacement, correction of electrolyte abnormalities, insulin therapy, management of triggers, and monitoring of maternal-fetal response to treatment.

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Noë and Niyondiko, L. (2024). Clinical Management of Diabetic Ketoacidosis in Pregnancy: A Review of Current Literature. Open Access Library Journal, 11, e2246. doi: http://dx.doi.org/10.4236/oalib.1112246.

References

[1]  Kalantzis, C. and Pappa, K. (2019) Diabetic ketoacidosis in pregnancy. Hellenic Journal of Obstetrics and Gynecology, 18, 21-25. https://doi.org/10.33574/hjog.1678
[2]  Mohan, M., Baagar, K.A.M. and Lindow, S. (2017) Management of Diabetic Ketoacidosis in Pregnancy. The Obstetrician & Gynaecologist, 19, 55-62. https://doi.org/10.1111/tog.12344
[3]  Dhanasekaran, M., Mohan, S. and Egan, A. (2022) Diabetic Ketoacidosis in Pregnancy: An Overview of Pathophysiology, Management, and Pregnancy Outcomes. EMJ Diabetes. https://doi.org/10.33590/emjdiabet/10194487
[4]  Eshkoli, T., Barski, L., Faingelernt, Y., Jotkowitz, A., Finkel-Oron, A. and Schwarzfuchs, D. (2022) Diabetic Ketoacidosis in Pregnancy—Case Series, Pathophysiology, and Review of the Literature. Euro-pean Journal of Obstetrics & Gynecology and Reproductive Biology, 269, 41-46. https://doi.org/10.1016/j.ejogrb.2021.12.011
[5]  Morrison, F.J.R., Movassaghian, M., Seely, E.W., Curran, A., Shubina, M., Mor-ton-Eggleston, E., et al. (2017) Fetal Outcomes after Diabetic Ketoacidosis during Pregnancy. Diabetes Care, 40, e77-e79. https://doi.org/10.2337/dc17-0186
[6]  Schneider, M.B., Umpierrez, G.E., Ramsey, R.D., Mabie, W.C. and Bennett, K.A. (2003) Pregnancy Complicated by Diabetic Ketoacidosis: Maternal and Fetal Out-comes. Diabetes Care, 26, 958-959. https://doi.org/10.2337/diacare.26.3.958
[7]  Diguisto, C., Strachan, M.W.J., Churchill, D., Ayman, G. and Knight, M. (2021) A Study of Diabetic Ketoacidosis in the Pregnant Population in the United Kingdom: Investigating the Incidence, Aetiology, Management and Outcomes. Diabetic Medicine, 39, e14743. https://doi.org/10.1111/dme.14743
[8]  Prior, M., Gopinath, D. and Schram, C. (2010) Gestational Diabetes Presenting as Diabetic Ketoacidosis. Archives of Disease in Childhood—Fetal and Neonatal Edition, 95, Fa61-Fa62. https://doi.org/10.1136/adc.2010.189753.96
[9]  Khan, M.J. and Uitto, K.A. (2010) Managing Severe Preeclampsia and Diabetic Ketoacidosis in Pregnancy. US Pharmacist, 35, HS-2-HS-8. https://www.uspharmacist.com/article/managing-severe-preeclampsia-and-diabetic-ketoacidosis-in-pregnancy
[10]  Villavicencio, C.A., Franco-Akel, A. and Belokovskaya, R. (2022) Diabetic Ketoacidosis Complicating Gestational Diabetes Mellitus. AACE Clinical Case Reports, 8, 221-223. https://doi.org/10.1016/j.aace.2022.07.002
[11]  Magliano, D.J. and Boyko, E.J. (2021) IDF Diabetes Atlas, 10th Edition. https://www.ncbi.nlm.nih.gov/books/NBK581934/
[12]  International Diabetes Federation (2019) Diabetes Atlas, Ninth Edi-tion. https://diabetesatlas.org/upload/resources/material/20200302_133351_IDFATLAS9e-final-web.pdf
[13]  Benoit, S.R., Zhang, Y., Geiss, L.S., Gregg, E.W. and Albright, A. (2018) Trends in Diabetic Ketoacidosis Hospitalizations and In-Hospital Mortality—United States, 2000-2014. MMWR. Morbidity and Mortality Weekly Report, 67, 362-365. https://doi.org/10.15585/mmwr.mm6712a3
[14]  Sibai, B.M. and Viteri, O.A. (2014) Diabetic Ketoacidosis in Pregnancy. Obstetrics & Gynecology, 123, 167-178. https://doi.org/10.1097/aog.0000000000000060
[15]  Long, B., Lentz, S., Koyfman, A. and Gottlieb, M. (2021) Euglycemic Diabetic Ketoacidosis: Etiologies, Evaluation, and Management. The American Journal of Emergency Medicine, 44, 157-160. https://doi.org/10.1016/j.ajem.2021.02.015
[16]  Brutsaert, E.F. (2022) Diabetic Ketoacidosis (DKA). https://www.msdmanuals.com/professional/endocrine-and-metab olic-disorders/diabetes-mellitus-and-disorders-of-carbohydr ate-metabolism/diabetic-ketoacidosis-dka#:~:text=Pathophysiolo gy%20of%20DKA,rise%20because%20of%20unrestrained%20lipolysis
[17]  Kamalakannan, D., Baskar, V., Barton, D.M. and Abdu, T.A.M. (2003) Diabetic Ketoacidosis in Pregnancy. Postgraduate Medical Jour-nal, 79, 454-457. https://doi.org/10.1136/pmj.79.934.454
[18]  Nasa, P., Chaudhary, S., Shrivastava, P.K. and Singh, A. (2021) Euglycemic Diabetic Ketoacidosis: A Missed Diagnosis. World Journal of Diabetes, 12, 514-523. https://doi.org/10.4239/wjd.v12.i5.514
[19]  Plewa, M. C., Bryant, M. and King-Thiele, R. (2023) Euglycemic Diabetic Ketoaci-dosis. https://europepmc.org/article/nbk/nbk554570
[20]  Calimag, A.P.P., Chlebek, S., Lerma, E.V. and Chaiban, J.T. (2023) Diabetic Ke-toacidosis. Disease-A-Month, 69, Article ID: 101418. https://doi.org/10.1016/j.disamonth.2022.101418
[21]  Joint British Diabetes Societies Inpatient Care Group (2013) The Management of Diabetic Ketoacidosis in Adults. https://www.mkuh.nhs.uk/wp-content/uploads/2022/07/DKA-guideline-with-refs-Sept-2013.pdf
[22]  Aldhaeefi, M., Aldardeer, N.F., Alkhani, N., Alqarni, S.M., Alhammad, A.M. and Alshaya, A.I. (2022) Updates in the Management of Hyperglycemic Crisis. Fron-tiers in Clinical Diabetes and Healthcare, 2, Article 820728. https://doi.org/10.3389/fcdhc.2021.820728
[23]  El-Remessy, A.B. (2022) Diabetic Ketoacidosis Management: Updates and Challenges for Specific Patient Population. Endocrines, 3, 801-812. https://doi.org/10.3390/endocrines3040066
[24]  Dargel, S., Schleußner, E., Kloos, C., Groten, T. and Weschenfelder, F. (2021) Awareness of Euglycaemic Diabetic Ketoacidosis during Pregnancy Prevents Recurrence of Devastating Outcomes: A Case Report of Two Pregnancies in One Patient. BMC Pregnancy and Childbirth, 21, Article No. 552. https://doi.org/10.1186/s12884-021-04035-6
[25]  Eledrisi, M.S., Beshyah, S.A. and Malik, R.A. (2021) Management of Diabetic Ketoacidosis in Special Populations. Diabetes Research and Clinical Practice, 174, Article ID: 108744. https://doi.org/10.1016/j.diabres.2021.108744
[26]  Evans, K. (2019) Diabetic Ketoacidosis: Update on Management. Clinical Medi-cine, 19, 396-398. https://doi.org/10.7861/clinmed.2019-0284
[27]  Mohan, N. and Banerjee, A. (2021) Metabolic Emergencies in Pregnancy. Clinical Medicine, 21, e438-e440. https://doi.org/10.7861/clinmed.2021-0496
[28]  Gabbe, S.G., Carpenter, L.B. and Gar-rison, E.A. (2007) New Strategies for Glucose Control in Patients with Type 1 and Type 2 Diabetes Mellitus in Pregnancy. Clinical Obstetrics & Gynecology, 50, 1014-1024. https://doi.org/10.1097/grf.0b013e31815a6435
[29]  Gosmanov, A.R., Gosmanova, E. and Dillard-Cannon, E. (2014) Management of Adult Diabetic Ketoacidosis. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy, 7, 255-264. https://doi.org/10.2147/dmso.s50516
[30]  van Amesfoort, J.E., Werter, D.E., Painter, R.C. and Hermans, F.J.R. (2021) Severe Metabolic Ketoacidosis as a Primary Manifestation of SARS-CoV-2 Infection in Non-Diabetic Pregnancy. BMJ Case Reports, 14, e241745. https://doi.org/10.1136/bcr-2021-241745
[31]  Karslioglu French, E., Donihi, A.C. and Korytkowski, M.T. (2019) Diabetic Ketoacidosis and Hyperosmolar Hyperglycemic Syndrome: Review of Acute Decompensated Diabetes in Adult Pa-tients. BMJ, 365, L1114. https://doi.org/10.1136/bmj.l1114
[32]  Allen, S.J. (2014) Fluid Therapy and Outcome: Balance Is Best. The Journal of ExtraCorporeal Technology, 46, 28-32. https://doi.org/10.1051/ject/201446028
[33]  Epstein, E.M. and Waseem, M. (2022) Crystalloid Fluids. https://pubmed.ncbi.nlm.nih.gov/30726011/
[34]  Dhatariya, K.K. (2022) The Management of Diabetic Ketoacidosis in Adults—An Updated Guideline from the Joint British Diabetes Society for Inpatient Care. Diabetic Medicine, 39, e14788. https://doi.org/10.1111/dme.14788
[35]  Chua, H., Venkatesh, B., Stachowski, E., Schneider, A.G., Perkins, K., Ladanyi, S., et al. (2012) Plasma-Lyte 148 vs 0.9% Saline for Fluid Resuscitation in Diabetic Ketoacidosis. Journal of Critical Care, 27, 138-145. https://doi.org/10.1016/j.jcrc.2012.01.007
[36]  Mahler, S.A., Conrad, S.A., Wang, H. and Arnold, T.C. (2011) Resuscitation with Balanced Electrolyte Solution Prevents Hyperchloremic Metabolic Acidosis in Patients with Diabetic Ketoacidosis. The American Journal of Emergency Medicine, 29, 670-674. https://doi.org/10.1016/j.ajem.2010.02.004
[37]  Van Zyl, D.G., Rheeder, P. and Del-port, E. (2011) Fluid Management in Diabetic-Acidosis—Ringer’s Lactate versus Normal Saline: A Randomized Controlled Trial. QJM, 105, 337-343. https://doi.org/10.1093/qjmed/hcr226
[38]  Self, W.H., Evans, C.S., Jenkins, C.A., Brown, R.M., Casey, J.D., Collins, S.P., et al. (2020) Clinical Effects of Balanced Crystalloids vs Saline in Adults with Diabetic Ketoacidosis: A Subgroup Analy-sis of Cluster Randomized Clinical Trials. JAMA Network Open, 3, e2024596. https://doi.org/10.1001/jamanetworkopen.2020.24596
[39]  Ramanan, M., Attokaran, A., Murray, L., Bhadange, N., Stewart. D., Rajendran, G., Venkatesh, B., et al. (2021) Sodium Chloride or Plasmalyte-148 Evaluation in Severe Diabetic Ketoacidosis (SCOPE-DKA)—A Cluster, Crossover, Randomized, Controlled Trial. Intensive Care Medicine, 47, 1248-1257.
[40]  Barski, L., Eshkoli, T., Brandstaetter, E. and Jotkowitz, A. (2019) Euglycemic Diabetic Ketoacidosis. European Journal of Internal Medicine, 63, 9-14. https://doi.org/10.1016/j.ejim.2019.03.014
[41]  Grout, S., Maue, D., Berrens, Z., Swinger, N. and Malin, S. (2022) Diabetic Ketoacidosis with Refractory Hypokalemia Leading to Cardiac Arrest. Cureus, 14, e23439. https://doi.org/10.7759/cureus.23439
[42]  Abdulaziz, S., Dabbagh, O., Al Daker, M.O. and Hassan, I. (2012) Hypokalaemia and Re-fractory Asystole Complicating Diabetic Ketoacidosis, Lessons for Prevention. BMJ Case Reports, 2012, bcr-2012-007312. https://doi.org/10.1136/bcr-2012-007312
[43]  Arora, S., Cheng, D., Wyler, B. and Menchine, M. (2012) Prevalence of Hypokalemia in ED Patients with Diabetic Ketoacidosis. The American Journal of Emergency Medicine, 30, 481-484. https://doi.org/10.1016/j.ajem.2011.01.002
[44]  Dhanasekaran, M., Mohan, S., Erickson, D., Shah, P., Szymanski, L., Adrian, V., et al. (2022) Diabetic Ketoacidosis in Pregnancy: Clinical Risk Factors, Presentation, and Outcomes. The Journal of Clinical Endocrinol-ogy & Metabolism, 107, 3137-3143. https://doi.org/10.1210/clinem/dgac464
[45]  Castro, D. and Sharma, S. (2023) Hypokalemia. https://pubmed.ncbi.nlm.nih.gov/29494072/
[46]  Veciana, M.d. (2013) Diabetes ketoacidosis in pregnancy. Seminars in Perinatology, 37, 267-273. https://doi.org/10.1053/j.semperi.2013.04.005
[47]  Goyal, N., Miller, J.B., Sankey, S.S. and Mossallam, U. (2010) Util-ity of Initial Bolus Insulin in the Treatment of Diabetic Ketoacidosis. The Journal of Emergency Medicine, 38, 422-427. https://doi.org/10.1016/j.jemermed.2007.11.033
[48]  Kitabchi, A.E., Murphy, M.B., Spencer, J., Matteri, R. and Karas, J. (2008) Is a Priming Dose of Insulin Necessary in a Low-Dose Insulin Protocol for the Treatment of Diabetic Ketoacidosis?.Diabetes Care, 31, 2081-2085. https://doi.org/10.2337/dc08-0509
[49]  Brown, H., Tran, R. and Patka, J. (2018) Effect of Bolus Insulin Administration Followed by a Continuous Insulin Infusion on Diabetic Ketoacidosis Management. Pharmacy, 6, Article 129. https://doi.org/10.3390/pharmacy6040129
[50]  Kohler, K. and Levy, N. (2014) Management of Diabetic Ketoacidosis: A Summary of the 2013 Joint British Diabetes Societies Guidelines. Journal of the Intensive Care Society, 15, 222-225. https://doi.org/10.1177/175114371401500309
[51]  Umpierrez, G.E., Jones, S., Smiley, D., Mulligan, P., Keyler, T., Temponi, A., et al. (2009) Insulin Analogs versus Human Insulin in the Treatment of Patients with Diabetic Ketoacidosis. Diabetes Care, 32, 1164-1169. https://doi.org/10.2337/dc09-0169
[52]  Agarwal, S., Gupta, M. and Gunn, S. (2019) Use of Inhaled Insulin in a Patient with Subcutaneous Insulin Resistance Syndrome: A Rare Condition. AACE Clinical Case Reports, 5, e187-e191. https://doi.org/10.4158/accr-2018-0493
[53]  Shafiee, G., Mohajeri-Tehrani, M., Pajouhi, M. and Larijani, B. (2012) The Importance of Hypoglycemia in Diabetic Patients. Journal of Diabetes & Metabolic Disorders, 11, Article No. 17. https://doi.org/10.1186/2251-6581-11-17
[54]  Kitabchi, A.E., Umpierrez, G.E., Miles, J.M. and Fisher, J.N. (2009) Hyperglycemic Crises in Adult Patients with Diabetes. Diabetes Care, 32, 1335-1343. https://doi.org/10.2337/dc09-9032
[55]  Prest, R. (2021) Hypo-glycaemia. https://em3.org.uk/foamed/27/01/2016/hypoglycaemia
[56]  Duhon, B., Attridge, R.L., Franco-Martinez, A.C., Maxwell, P.R. and Hughes, D.W. (2013) Intravenous Sodium Bicarbonate Therapy in Severely Acidotic Diabetic Ketoacidosis. Annals of Phar-macotherapy, 47, 970-975. https://doi.org/10.1345/aph.1s014
[57]  Chua, H.R., Schneider, A. and Bellomo, R. (2011) Bicarbonate in Diabetic Ketoacidosis—A Systematic Review. Annals of Intensive Care, 1, Article No. 23. https://doi.org/10.1186/2110-5820-1-23
[58]  Patel, M.P., Ahmed, A., Gunapalan, T. and Hesselbacher, S.E. (2018) Use of Sodium Bicarbonate and Blood Gas Monitoring in Diabetic Ketoacidosis: A Review. World Journal of Diabetes, 9, 199-205. https://doi.org/10.4239/wjd.v9.i11.199

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