(1118) Outcomes of patients with euglycemic versus hyperglycemic diabetic ketoacidosis during pregnancy

Euglycemic diabetic ketoacidosis (DKA) is uncommon in the adult non-pregnant diabetic population, but is more common in pregnancy. Our objective was to evaluate the outcomes of DKA admissions in pregnant patients with euglycemic versus hyperglycemic DKA.

Study Design:

This was a retrospective cohort study of individuals with diabetes admitted with DKA during pregnancy. They were classified as euglycemic if their admission blood glucose was < 250 mg/dL. The primary outcome was the duration of time between diagnosis of anion gap metabolic acidosis and anion gap closure. Secondary outcomes included admission to the intensive care unit, total insulin received between diagnosis of DKA and anion gap closure, and total crystalloid volume. For continuous variables, normality testing was done using the Shapiro-Wilk test and data compared using Student t-test or Mann-Whitney-U test as appropriate. Categorical variables were compared using Fisher’s exact or Chi Squared test.

Results:

Euglycemic DKA was present in 78 (50%) of 156 included individuals with DKA. Those with euglycemic DKA had a lower blood glucose, beta-hydroxybutyrate, hemoglobin A1c, and anion gap compared to those with hyperglycemic DKA. Time between diagnosis of DKA and anion gap closure was longer in those with euglycemic DKA (median 14.8 hours vs 11.6 hours), however volume of crystalloid and amount of insulin did not differ between the groups.

Conclusion:

Euglycemic DKA is associated with a longer time to anion gap closure despite a lower admission anion gap and beta-hydroxybutyrate level.