Diabetic ketoacidosis in pregnancy tends to occur at lower blood glucose levels: Case-control study and a case report of euglycemic diabetic ketoacidosis in pregnancy

2008 ◽  
Vol 34 (3) ◽  
pp. 324-330 ◽  
Author(s):  
Rui-Xia Guo ◽  
Ling-Zhu Yang ◽  
Liu-Xia Li ◽  
Xue-Ping Zhao
2021 ◽  
Vol 28 (06) ◽  
pp. 902-906
Author(s):  
Sassi Kanwal ◽  
Ashba Allahwasaya ◽  
Nargis Anjum ◽  
Syeda Sadia Fatima

Objectives: The purpose of the current study was to compare the serum Apelin level in patients with and without polycystic ovarian syndrome to assess this as a diagnostic marker for PCOS. In a case-control study 60 polycystic ovarian syndrome patients diagnosed according to Rotterdam criteria and 20 healthy controls of reproductive age group were recruited. Study Design: Case Control study. Setting: Jinnah Postgraduate Medical Center in Collaboration with Aga Khan University, Karachi. Period: August 2017 and February 2019. Material & Methods: Blood samples were collected after 12 hours fasting and was used to test serum Apelin, insulin, cortisol and fasting blood glucose levels. Results: Seventy percent PCO subjects had irregular menstrual cycle and 68% suffered from hirsutism; while all PCO subjects had more than 10 antral follicle seen on ultrasound in either one or both ovaries in comparison of 15% controls (p<0.05). Higher Apelin and Testosterone levels in PCO group was reported when compared with controls (p<0.05) across all BMI categories. Apelin showed a positive correlation with number of ovarian cysts (r=0.429; p=0.000); irregular menstrual cyle (r=0.276;p=0.13); blood glucose level (r=0.270; p=0.015) and BMI (r=0.229; p=0.14). Apelin remained independently associated with the risk of PCOS (p=0.020) and elevated testosterone levels (p=0.030). Conclusion: Serum Apelin showed a strong association with irregular menstruation, hirsutism, ovarian cysts, testosterone and deranged blood glucose levels. Therefore, Apelin appears as a potential source for several risk factor in PCOS women of all BMI types.


2019 ◽  
Vol 2019 ◽  
pp. 1-5 ◽  
Author(s):  
Johnny F. Jaber ◽  
Matthew Standley ◽  
Raju Reddy

Diabetic ketoacidosis (DKA) in pregnancy is associated with high fetal mortality rates. A small percentage of DKA occurs in the absence of high glucose levels seen in traditional DKA. Prompt recognition and management is crucial. We report a case of a 30-year-old pregnant woman with type 1 diabetes mellitus admitted with euglycemic DKA (blood glucose <200 mg/dL). Initial laboratory testing revealed a severe anion gap acidosis with pH 7.11, anion gap 23, elevated β-hydroxybutyric acid of 9.60 mmol/L, and a blood glucose of 183 mg/dL—surprisingly low given her severe acidosis. The ketoacidosis persisted despite high doses of glucose and insulin infusions. Due to nonresolving acidosis, her hospital course was complicated by spontaneous intrauterine fetal demise. Euglycemia and severe acidosis continued to persist until delivery of fetus and placenta occurred. It was observed that the insulin sensitivity dramatically increased after delivery of fetus and placenta leading to rapid correction of ketoacidosis. This case highlights that severe ketonemia can occur despite the absence of severely elevated glucose levels. We discuss the mechanism that leads to this pathophysiologic state and summarize previously published case reports about euglycemic DKA in pregnancy.


Author(s):  
Vandna Singh ◽  
Neeta Natu ◽  
Artika Sudhir Gupta

Background: Thyroid disease is one of the commonest endocrine disorder affecting women of reproductive age, and when untreated during pregnancy is associated with an increased risk of complications. The objective of this review was to increase awareness and to provide a review on adverse effect of thyroid dysfunction on maternal and perinatal outcome.Methods: This prospective, observational hospital-based case-control study carried on women coming for antenatal check-up in a Tertiary Care Hospital in INDORE from May 2018-December 2018. 50 known booked antenatal (case) patient with established thyroid disorder, more than 32 week of gestation, and 50-matched euthyroid patients (control) were taken.Results: Women suffering from overt and subclinical hypothyroidism and hyperthyroidism are nulliparous in 72% cases as compared to 32% in euthyroid patient. Increased maternal age was associated with higher incidence of thyroid dysfunction. Normal vaginal delivery by spontaneous labour seen in 56% of euthyroid, while it is reduced with thyroid dysfunction. 38% of altered thyroid profile patient undergo induction of labour and 24% cases undergo caesarean section as compared to control (17%). Adverse fetal outcome like intrauterine growth retardation, preterm birth and ICU admission seen increased with thyroid dysfunction  as compared to euthyroid patients.Conclusions: Thyroid dysfunction in pregnancy, although has a low incidence, but is associated with adverse maternal and fetal implications. Thus, thyroid screening should be done in antenatal period to improve fetomaternal outcome.


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