THU316 Relatively Rare And Increasingly Fatal; A Case Of Euglycemic DKA In A Patient With Gestational Diabetes

Disclosure: C. Dimech: None. E. Rabiei-Flori: None. P.L. Bononi: None. Diabetic ketoacidosis (DKA) is an endocrine emergency and can be a catastrophic event during pregnancy, increasing both maternal and fetal mortality. Euglycemic DKA (EDKA) during pregnancy is a rare, acute, life-threatening emergency characterized by euglycemia, metabolic acidosis and ketosis. EDKA has been reported in pregnancies complicated by Type 1 diabetes, Type 2 diabetes and gestational diabetes. Unlike DKA, the diagnosis of EDKA is often overlooked because of the absence of hyperglycemia. The incidence of DKA and EDKA are higher during pregnancy due to physiologic changes of increasing insulin resistance from human placental lactogen, placental insulinase, and progesterone which result in a relative insulin deficiency as the pregnancy progresses. Additionally, tocolytic therapy to delay preterm labor and antenatal corticosteroids given to promote fetal lung development, pose unique triggering factors in pregnancy which can further precipitate DKA. We report a case of EDKA in a 37-year-old G2P0010 Caucasian female at 29 week 6 day gestation with recently diagnosed gestational diabetes on diet therapy (HbA1c 6.3%), who was admitted for atypical preeclampsia. Initial laboratory studies revealed an anion gap metabolic acidosis (anion gap=24, arterial pH 7.242) with euglycemia (blood glucose 123mg/dL). She underwent emergent C-section 24 hours after admission due to development of pre-eclampsia with severe features. Despite delivery, she had persistent and worsening high anion gap metabolic acidosis (HAGMA). The Endocrinology service was consulted and ordered a beta hydroxybutyrate level which was elevated at 6.18mmol/L (0.02-0.30mmol/L) with 3+ ketonuria. Intravenous insulin and dextrose were instituted with gradual improvement in acidosis. EDKA is an easily missed diagnosis that should always be considered during pregnancy in a patient with high anion gap metabolic acidosis. Prompt recognition and treatment is essential to minimize complications to mother and fetus. Presentation: Thursday, June 15, 2023