Medical disorders in pregnancyFree in the app
DKA in pregnancy
Can occur with near-normal glucose. Treat the mother to save the baby.
Source: OAA Quick Reference Handbook · JBDSDiagnosis
| Acidosis | pH below 7.3 and/or bicarbonate below 15 mmol/L. |
|---|---|
| Glucose | Above 11 mmol/L or known diabetes — but euglycaemic DKA is common in pregnancy. |
| Ketones | Blood above 3 mmol/L or urine 2+ or more. |
Management
- Fluids: SBP below 90 — 500 ml 0.9% saline over 15 min, repeat; SBP 90 or more — 1 litre over 1 hour.
- Fixed-rate insulin 0.1 units/kg/h (actual weight, max 14 units/h). Continue long-acting insulin.
- When glucose falls below 14 mmol/L, add 10% glucose at 50 ml/h.
- Potassium from the second bag: none if above 5.5; 40 mmol/L if below 5.5; ICU if below 3.5.
- Hourly glucose and ketones; venous gas at 1, 2 and 4 hours.
- Look for the trigger: steroids, beta-agonists, infection, vomiting.
An abnormal CTG usually recovers as the acidosis corrects. Stabilise the mother; do not rush to deliver for the CTG alone.
A summary for trained clinicians. Always check the full guideline, the patient in front of you and your hospital's protocol. Spotted an error? Tell us.