Case Report: Diabetic Ketoacidosis During Pregnancy Due to Insulin Omission

Diabetic ketoacidosis is an acute and severe complication commonly occurring in individuals with type-1 diabetes mellitus due to absolute insulin deficiency. A 28-year-old Black woman, gravida 2, para 2, secondary school teacher was admitted at 31 weeks of gestation to the obstetric ward on August 12/2022 with a two-day history of nausea and vomiting. She had a history of insulin-dependent diabetes mellitus four years earlier. She missed her insulin dose one day due to traveling to the village for greeting her family. She presented with a two-day history of nausea and vomiting, and a one-day history of shortness of breath, abdominal tenderness, hypotension, elevated heart rate, increased respiratory rate, frequent urination, and fatigue. Ketone testing done using her urine sample showed ketonuria of 3+. Her chest X-ray revealed coarse crackles on auscultation. Her breath odor revealed acetone-smelling breathing. Upon admission, she was treated with insulin infusion for 24 hours and 60 milliequivalents per liter of potassium chloride intravenously was also initiated. On the same day, 0.9% of normal saline 500 mL was initiated intravenously stat and repeats until systolic blood pressure was greater than 90 mmHg. The main objectives of diabetic ketoacidosis management are to restore volume status, normalize hyperglycemia, replace electrolytes lost, and lower ketoacidosis.