GLUCOCORTICOID-INDUCED KETOACIDOSIS IN GESTATIONAL DIABETES - SEQUELAOF THE ACUTE TREATMENT OF PRETERM LABOR - A CASE-REPORT

Pregnancy induces complex changes in energy metabolism, manifested cli nically by insulin resistance, low fasting blood glucose levels, and p roneness to ketosis. It is quite unusual for pregnant women who do not have type I diabetes to progress from ketosis to frank ketoacidosis, although this phenomenon is common in larger mammals. In the case desc ribed here, glucocorticoid administration in the setting of a prolonge d fast triggered a metabolic cascade leading to ketoacidosis in a preg nant woman without type I diabetes. Other details of this illustrative case serve to synthesize several disparate observations regarding the pathogenesis of pregnancy ketoacidosis. Physicians should be aware of the potential for rapidly developing ketoacidosis with atypical bioch emical and clinical features in pregnant women who are treated with hi gh doses of glucocorticoids.