A 29-year-old woman with type 1 diabetes presents at 30 weeks with 2 days of vomiting and deep sighing respiration. Blood glucose is 185 mg/dL, pH 7.12, bicarbonate 8 mEq/L, and urine shows heavy ketonuria. What is the most likely diagnosis?

• A Lactic acidosis from sepsis
• B Hyperosmolar hyperglycaemic state
• C Euglycaemic diabetic ketoacidosis ✓
• D Severe iron deficiency causing metabolic acidosis

Explanation

In pregnancy, placental hormones increase insulin sensitivity while fetal and placental glucose consumption plus renal glucosuria lower plasma glucose, so ketoacidosis can develop at glucose values below 200 mg/dL. The combination of ketosis, high anion gap acidosis and modest hyperglycaemia defines euglycaemic DKA. Hyperosmolar state requires grossly elevated osmolality and glucose, and lactic acidosis lacks heavy ketonuria.

Reference: Fernando Arias' Practical Guide to High-Risk Pregnancy and Delivery, 5th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.