Endocrine Abstracts

Introduction: Diabetes is a recognized risk factor for the development of complications in COVID-19 infection, with an increased incidence of ketoacidosis observed in patients admitted to hospital.

Case Reports: We present the case of a patient with type 1 DM complicated by diabetic retinopathy and unplanned pregnancy (pregestational Hba1c 9.1%). In follow-up during pregnancy: progression of retinopathy and fetal renal pyeloectasia in morphological ultrasound at 20 weeks, HbA1c second trimester 6.8%. Consultation in the Obstetrics Emergency Room of a 29+4 week pregnant woman due to emetic symptoms of 3 days of evolution, showing ketoacidosis (fasting plasma glucose 287 mg/dl, pH 7.11 bicarbonate 5.7 mmol/l and ketonuria), and starting intravenous insulin and fluid therapy. In case of suspicion of COVID-19 contact, PCR Sars-CoV-2 is performed, which is positive. Cardiotocographic record (CTG) on admission: pattern according to gestational age and adequate fetal HR, limited variability in some section that recovers spontaneously. No sustained decelerations. Non-dynamic. Free Style Libre (previous 14 days): average glucose 155 mg/dl, GMI 7.0%, CVC 41.7%, time on target 65%, above target 29%. Although the patient did not present respiratory symptoms or vital compromise, it was decided to admit her to the intensive care for treatment and monitoring of ketoacidosis and obstetric control with continuous CTG. At 24 h, uterine dynamics is evident in the CTG, for which she receives tocolytic treatment with atosiban to inhibit contractions, magnesium sulfate and betamethasone for fetal lung maturation and a slight worsening of glycemic control. After intensifying intravenous insulin therapy, optimal fasting plasma glucose levels for pregnancy were achieved, but refractoriness in the control of ketoacidosis and intermittent oral tolerance prevented withdrawal of the insulin perfusion. On the 11^th day of admission (current gestation of 31+1 weeks) there was evidence of CTG, loss of fetal well-being and uterine dynamics, deciding to carry out an urgent caesarean section that proceeded without complications. After this, correction of ketoacidosis and improvement of oral tolerance were achieved, with withdrawal of intravenous insulin therapy and transfer to a conventional ward without complications.

Conclusions: We present this case emphasizing the importance of multidisciplinary management of diabetic ketoacidosis during pregnancy and the role that COVID-19 infection may have played.