# Complexities in Pregnancy: Diabetic Ketoacidosis Initially Thought to Be Hyperemesis Gravidarum Resulting in Early Fetal Demise

## TL;DR

A pregnant patient with diabetic ketoacidosis misdiagnosed as hyperemesis gravidarum led to fetal demise, highlighting the need for early detection of DKA in pregnancy.

## Contribution

This case report highlights the importance of distinguishing DKA from hyperemesis gravidarum to prevent adverse maternal and fetal outcomes.

## Key findings

- Covert DKA in early pregnancy was misdiagnosed as hyperemesis gravidarum, resulting in fetal demise.
- Early recognition and management of DKA in pregnancy are critical for maternal and fetal safety.
- Clinical awareness and vigilant fetal monitoring are essential for diabetic patients.

## Abstract

Hyperemesis gravidarum and diabetic ketoacidosis (DKA) can be difficult to distinguish in pregnant patients, as both conditions present with nausea, vomiting, and elevated ketones. Although uncommon, there should be a high index of suspicion for DKA in pregnant patients who exhibit these symptoms, given the potential for life-threatening maternal and fetal outcomes. Here we present a rare case of covert DKA in the first trimester of pregnancy that was initially diagnosed and treated as hyperemesis gravidarum due to the absence of a wide anion gap, which tragically resulted in fetal demise. The patient was admitted to the intensive care unit (ICU) and hospitalized for over a week but was eventually discharged in stable condition with a favorable prognosis. This report aims to contribute to clinical awareness of this metabolic complication and to emphasize the importance of prevention, early recognition, and timely management of DKA in pregnancy, along with vigilant fetal monitoring in diabetic patients.