A Neonate with Severe Acidosis Caused by Diabetic Ketoacidosis Associated with Maternal Fulminant Type 1 Diabetes

Fulminant type 1 diabetes mellitus (fulminant T1DM) can progress rapidly to diabetic ketoacidosis (DKA). It can develop in pregnant women with no prior history of diabetes, and such cases are associated with severe perinatal consequences. We report the detailed clinical course of a neonate born from a mother with DKA caused by fulminant T1DM. The male neonate weighed 3,024 grams and was born at 36 weeks of gestation. The patient's mother had an uneventful pregnancy until she visited the hospital on the day of delivery with headache, nausea, and decreased fetal movement. The APGAR score of the neonate was 8/8, but he was transferred to our hospital for further evaluation because umbilical cord blood gas analysis showed unexplained acidosis (pH = 6.92). We were later informed that the mother was diagnosed as having DKA due to fulminant T1DM after the neonate was born. On admission, laboratory testing of the neonate revealed hypoglycemia, hyperinsulinemia, and hyperkalemia, all of which were induced by the mother's metabolic condition. Intravenous glucose supplementation resolved the neonate's metabolic derangement, and he was discharged on day 10. He showed no neurological abnormalities, but magnetic resonance imaging showed lesions indicating hypoglycemic encephalopathy. Maternal fulminant T1DM and DKA should be considered in neonates with severe metabolic acidosis. Even a neonate who is asymptomatic at birth may rapidly develop severe disease.