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Diabetes Mellitus Type 1 Presenting in the Setting of Diabetic Ketoacidosis and Acute SARS-CoV-2 Infection in Pregnancy.

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العنوان: Diabetes Mellitus Type 1 Presenting in the Setting of Diabetic Ketoacidosis and Acute SARS-CoV-2 Infection in Pregnancy.
المؤلفون: Stamatiades GA; Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts., Galbiati F; Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts., Fitzgerald AC; Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts., McDonnell ME; Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts., Lassey SC; Division of Maternal-Fetal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts., Palermo NE; Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
المصدر: AACE clinical case reports [AACE Clin Case Rep] 2023 Apr 14. Date of Electronic Publication: 2023 Apr 14.
Publication Model: Ahead of Print
نوع المنشور: Case Reports
اللغة: English
بيانات الدورية: Publisher: Elsevier Inc Country of Publication: United States NLM ID: 101670593 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2376-0605 (Electronic) Linking ISSN: 23760605 NLM ISO Abbreviation: AACE Clin Case Rep
أسماء مطبوعة: Publication: 2021- : [New York] : Elsevier Inc.
Original Publication: Jacksonville, FL : American Association of Clinical Endocrinologists, [2015]-
مستخلص: Background/objective: Diabetic ketoacidosis (DKA) during pregnancy is an obstetric emergency associated with a higher rate of maternofetal morbidity and mortality. Pregnancy itself is a ketosis-prone state and several unique mechanisms predispose to the development of insulin resistance, which can be further exacerbated by acute stressors such as infection. Thus, pregnant patients who additionally contract COVID-19 may be at an even higher risk of development of DKA.
Case Report: A 32-year-old patient, with no prior history of impaired glucose tolerance, presented at 27 weeks of gestation with a 3-day history of shortness of breath, congestion, loss of taste and smell, polyuria, and polydipsia. Biochemical evaluation was consistent with DKA. Subsequently, she was diagnosed with acute SARS-CoV-2 infection. Treatment included intravenous hydration, electrolyte replacement, and insulin infusion. Postpartum phenotypic evaluation confirmed autoimmune diabetes (positive GAD-65 and zinc T8 antibodies) with residual β-cell function. Six months postpartum, glycemic control remains at goal with basal- bolus insulin regimen.
Discussion: This case describes the peculiar ability of SARS-CoV-2 infection to potentially rouse autoimmunity and how COVID-19 and DKA in pregnancy can be particularly challenging given the risk of significant maternal and fetal morbidity and mortality.
Conclusion: Prompt diagnosis and evaluation of DKA in pregnancy as well as a higher level of suspicion is needed in the setting of SARS-CoV-2 infection. Additionally, this case depicts the need for closely monitoring the postpartum period for patients at risk of autoimmune disease, which may have been blunted in pregnancy.
Competing Interests: The authors have no multiplicity of interest to disclose.
(© 2023 AACE. Published by Elsevier Inc.)
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معلومات مُعتمدة: T32 DK007529 United States DK NIDDK NIH HHS
فهرسة مساهمة: Keywords: COVID-19; DKA; Pregnancy; diabetic ketoacidosis
تواريخ الأحداث: Date Created: 20230626 Latest Revision: 20240409
رمز التحديث: 20240409
مُعرف محوري في PubMed: PMC10102535
DOI: 10.1016/j.aace.2023.04.006
PMID: 37363439
قاعدة البيانات: MEDLINE
الوصف
تدمد:2376-0605
DOI:10.1016/j.aace.2023.04.006