Diabetic ketoacidosis in pregnancy with respiratory and latent syphilis infection: a case report

Abstract

Introduction: DKA in pregnancy is a rare and life-threatening condition. In general, this case occurs more often in patients with a history of Type I Diabetes Mellitus (DM) compared to Type II DM or gestational DM.

Case: A 33-year-old pregnant woman (G2P1A0) 20 weeks and 6 days of gestation complaints of shortness of breath accompanied by fever, dry cough, and nausea and vomiting. She had not felt fetal movements since one day before admission. The patient had a history of type II DM. From examination, a respiratory rate of 28 breaths per minute with Kussmaul breathing, a heart rate of 92 beats per minute, body temperature of 37.7°C, and tenderness in the epigastrium. Complete blood count showed WBC 20.21 x 10³/µL with blood gas analysis was acidosis metabolic, urinalysis showed ketones +4, Glucose +4, Protein +1, and TPHA reactive. Chest X-ray examination found bronchitis and abdominal USG showed no fetal heartbeat and fetal movement. The patient showed significant improvement after administration of therapy.

Discussion: Physiologically, pregnancy carries a risk for DKA due to increased insulin resistance and ketogenesis. This risk will increase with the presence of precipitating factors such as infection. The infection will trigger the release of pro-inflammatory cytokines and counter-regulatory hormones such as cortisol or adrenaline which trigger ketoacidosis.

Conclusion: A multidisciplinary approach to managing DKA is crucial to minimizing maternal and infant mortality. Pre-pregnancy education and counseling should be provided to all women planning to become pregnant, whether with or without a history of diabetes.