Diabetic Ketoacidosis

Diabetic ketoacidosis (DKA) is a complication of diabetes characterized by severe dehydration, electrolyte disturbances, and ketoacidosis. Blood glucose and ketone levels are regulated by insulin and the counterregulatory hormones glucagon, epinephrine, norepinephrine, cortisol, and growth hormone. The decrease in malonyl-CoA stops fatty acid synthesis and activates carnitine palmitoyltransferase-1 to facilitate ketogenesis via the carnitine shuttle. The energy demands of the placenta and fetus coupled with the effects of placental hormones make the pregnant woman more likely to develop ketoacidosis than the non-pregnant woman, whether or not she has diabetes. Prominent symptoms of DKA in pregnancy include nausea, vomiting, abdominal pain, shortness of breath, and generalized weakness. Clinical examination should assess maternal cardiovascular, pulmonary, and mental status as well as the condition of the fetus. The effective serum osmolality reflects the status of hydration of both the intracellular and extracellular compartments. In DKA, the osmotic diuresis induced by glycosuria causes the extracellular sodium concentration to increase.