Diagnosis and Management of Euglycemic Diabetic Ketoacidosis in Pregnancy

Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes mellitus. Euglycemic DKA -a variant of DKA with normal to mildly elevated blood glucose levels (less than 200 mg/dL) that is more common in pregnancy-presents significant diagnostic and treatment challenges. The physiologic adaptations that occur during pregnancy create an environment that makes pregnant patients highly susceptible to euglycemic DKA, with recent data suggesting that up to 35% of DKA cases in pregnancy present with euglycemia. Management cornerstones for euglycemic DKA include aggressive intravenous fluid resuscitation with dextrose-containing fluids, intravenous insulin to halt ketogenesis, and the correction of electrolyte imbalances. Due to the increasing prevalence of diabetes in pregnancy, clinician awareness of euglycemic DKA is crucial, as timely diagnosis and intervention are essential to mitigate adverse maternal and fetal outcomes. In this narrative review, we describe the unique pathophysiology that increases pregnant patients' susceptibility to euglycemic DKA, outline diagnostic intricacies, and detail specific management strategies for this population.