未经证实:妊娠期糖尿病(GDM)中糖尿病酮症酸中毒(DKA)的患病率非常低。我们描述了一名GDM患者,在不坚持治疗的情况下,严重的DKA伴有宫内胎儿死亡。
未经授权:一名33岁的妇女,G2P0010,在妊娠30周时没有预先存在的糖尿病(DM),伴有急性发作的感觉改变,恶心,和呕吐。GDM在妊娠15周时被诊断为在1小时50克葡萄糖攻击测试后血清葡萄糖水平为266mg/dL(70-134mg/dL)。GMD诊断时糖化血红蛋白(HbA1C)为5.9%(41mmol/mol)。胰岛素在妊娠第20周开始。在介绍时,血清葡萄糖水平为920mg/dL(70-110mg/dL),pH值为7.02(7.32-7.43),38mmol(5-17mmol)的阴离子间隙水平,碳酸氢盐水平为5.0mEq/L(22-29mEq/L),发现了大量的血清酮。超声显示胎儿宫内死亡。她接受了静脉输液和连续胰岛素。在自然分娩无法存活的胎儿后,DKA解决了。抗谷氨酸脱羧酶阴性,胰岛细胞,和锌转运蛋白8抗体,C肽水平为2.4ng/dL(1.1-4.4ng/dL),发现HbA1C水平为9%(75mmol/mol)。住院管理包括基础推注和滑动量表胰岛素治疗。入院后7天出院时加入二甲双胍。在3个月和6个月的随访中,HbA1C水平分别为5.3%(34mmol/mol)和5%(31mmol/mol)。分别。停用胰岛素。目前,患者正在服用二甲双胍和胰高血糖素样肽1受体激动剂。
UASSIGNED:妊娠期胰岛素抵抗的发展是由多种因素驱动的。大约1%至2%的糖耐量受损的孕妇会发生DKA;大多数病例发生在1型DM妇女中。DKA在GDM中的大约发生率为0.02%。
未经批准:使GDM复杂化的DKA极为罕见,但它不能被驳回。早期识别以及及时和适当的医疗和产科管理至关重要。
UNASSIGNED: The prevalence of diabetic ketoacidosis (DKA) in gestational diabetes mellitus (GDM) is very low. We describe a patient with GDM in whom severe DKA with intrauterine fetal demise developed in the setting of nonadherence to therapy.
UNASSIGNED: A 33-year-old woman, G2P0010, with no preexisting diabetes mellitus (DM) presented at 30 weeks of gestation with acute-onset altered sensorium, nausea, and emesis. GDM was diagnosed at 15 weeks of gestation with a serum glucose level of 266 mg/dL (70-134 mg/dL) after 1-hour 50-gram glucose challenge test. Glycated hemoglobin (HbA1C) was 5.9% (41 mmol/mol) at the time of GMD diagnosis. Insulin was initiated at week 20 of gestation. On presentation, serum glucose level of 920 mg/dL (70-110 mg/dL), pH of 7.02 (7.32-7.43), anion gap level of 38 mmol (5-17 mmol), bicarbonate level of 5.0 mEq/L (22-29 mEq/L), and large serum ketones were found. Ultrasound showed intrauterine fetal demise. She received intravenous fluids and continuous insulin. Following the spontaneous delivery of a nonviable fetus, DKA was resolved. Negative antiglutamic acid decarboxylase, islet cell, and zinc transporter 8 antibodies, C-peptide level of 2.4 ng/dL (1.1-4.4 ng/dL), and HbA1C level of 9% (75 mmol/mol) were found. Inpatient management included basal-bolus and sliding scale insulin therapies. Metformin was added upon discharge 7 days after admission. The HbA1C levels were 5.3% (34 mmol/mol) and 5% (31 mmol/mol) at the 3- and 6-month follow-ups, respectively. Insulin was discontinued. Currently, the patient is on metformin and glucagon-like peptide 1 receptor agonist.
UNASSIGNED: The development of insulin resistance during pregnancy is driven by multiple factors. Approximately 1% to 2% of pregnant women with impaired glucose tolerance develop DKA; most cases occur in women with type 1 DM. The approximate incidence of DKA in GDM is 0.02%.
UNASSIGNED: DKA complicating GDM is extremely infrequent, but it cannot be dismissed. Early recognition along with prompt and appropriate medical and obstetrical management is critical.