An atypical postpartum course of diabetic ketoacidosis after preterm delivery: A case report

Diabetic ketoacidosis in pregnancy (DKP) is a rare but potentially life-threatening condition. Physiological changes during pregnancy increase susceptibility to DKP and may result in presentation at relatively normal blood glucose levels, making diagnosis challenging. We report the case of a 33-year-old para 3 woman with type 1 diabetes managed with an insulin pump who presented preterm with regular contractions. She was diagnosed with DKP based on biochemical findings and the presence of multiple precipitating factors. Despite prompt fluid resuscitation, insulin therapy, and electrolyte replacement, maternal acidosis worsened and fetal heart rate abnormalities developed, necessitating emergency delivery. An unusual feature was the persistence of elevated blood ketone levels for more than 24 h despite correction of acidosis, requiring prolonged insulin infusion. This case highlights the importance of early recognition, multidisciplinary management, and careful assessment of maternal and fetal status when considering the timing of delivery in DKP.