THU324 Euglycemic Diabetic Ketoacidosis Coinciding With COVID-19 Infection During Pregnancy

Abstract

Abstract Disclosure: M. Alkhathlan: None. A. Siddiqui: None. Background: Pregnancy is well known to be a diabetogenic and ketogenic state. When coinciding with an acute illness like COVID-19 infection, it can lead to full-blown DKA requiring intervention to reverse ketoacidosis. Complete restoration of normal glycemic status can be achieved after treatment of COVID-19 infection. Clinical case: A 34-year-old, G3 P2 woman who was at 26 weeks gestation with triplet pregnancy presented to the ED with fever, shortness of breath, nausea and vomiting for 3 days. She had gestational hypertension and impaired glucose tolerance during her previous pregnancy, but none during her current pregnancy. She had tested positive for COVID-19 infection at an outpatient evaluation for mild upper respiratory symptoms, two days prior to her presentation. Vital signs in the ER were T 35.3 °C, RR 22, HR 103, BP 121/70, and O2 sat 95% on 4 L/min nasal cannula. Initial laboratory testing showed sodium 132 (135-145), potassium 4.4 (3.5-5.5), bicarb 9 mmol/L (22-29), anion gap 18 mmol/L (5-14), BUN 3 mg/dL (6-23), creatinine 0.43, eGFR > 60, glucose 113 mg/dL (74-109), serum ketones 3.13 mmol/L (0.02-0.27) and lactate 1.6 mmol/L (0.5-2.5). ABG confirmed acidosis with pH of 7.29, and PCO2 was 22. She was diagnosed with euglycemic DKA after ruling out other possible etiologies of high anion gap metabolic acidosis. She received betamethasone by the Obstetrics team and fetal monitoring was initiated. DKA treatment was started with IV insulin, dextrose and close glucose monitoring. She had complete resolution of metabolic acidosis after 34 hours and did not require subcutaneous insulin treatment post-DKA resolution. She was able to tolerate oral diet with significant improvement of all her symptoms. She required only supportive treatment for COVID-19 infection and tested negative on the third day of hospitalization. Conclusion: Pregnancy is a ketogenic state and when superimposed with a significant acute illness of COVID-19, can lead to euglycemic DKA even in the absence of gestational diabetes. Early detection and treatment of ketoacidosis with COVID-19 is critical to avoid fetal and maternal complications or premature delivery. Presentation: Thursday, June 15, 2023