When the bump bumps up the sugar

Author: Matt Edwards / Editor: Steve Fordham / Reviewer: Raja Shahid Ali / Codes: HCPS4i / Published: 19/02/2021

A 32-year-old type 1 diabetic female presents at 30/40 gestation of her first pregnancy feeling generally unwell. She had been vomiting with mild lower abdominal pain and had been treated for a presumed UTI by the GP with a 3 day course of amoxicillin. Her urinary symptoms had improved, but over the past 24 hours she had been feeling increasingly unwell with fever and vomiting. Having been unable to keep any food down she did not take her insulin last night. She reports reduced fetal movements in the previous 24 hrs.

She has a gravid uterus consistent with a 3rd trimester pregnancy, she is flushed with dry mucous membranes. Her chest is clear, there is no evidence of skin infection and abdomen non tender. There is no focal source of infection found. Doppler exam reveals a present fetal heart beat at a rate of 185.

Initial observations record a RR 28, Sats 98% on air, HR 130, BP 100/60 Temp 37.8.

The obstetric and ITU registrars are contacted urgently and she is taken to the resuscitation room where she is given oxygen, IV access sited and 1L 0.9% Saline started. Urine is very positive for ketones but nothing else. Arterial Blood Gas shows a glucose of 14, pH of 7.31, pCO2 3.5, pO2 18.0, Bic 20.3, BE -7.8 Lactate 1.9, K 4.6

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