P. Liu, T. Li, S. Yu, F. Liu and L. Huang (2026). Multidisciplinary Management and Anesthesia Considerations for Diabetic Ketoacidosis With Hypertriglyceridemic Acute Pancreatitis in Pregnancy: A Case Report. The American journal of case reports, 27, e949837. https://doi.org/10.12659/AJCR.949837

PubMed 41479222

[Abstract]
BACKGROUND Pregnancy complicated by diabetic ketoacidosis (DKA) and hypertriglyceridemic acute pancreatitis (HTG-AP) is a grave and life-threatening emergency for both the expectant mother and the fetus. Physiological insulin resistance and dyslipidemia during pregnancy exacerbate these conditions, creating a vicious cycle of metabolic derangements and systemic inflammation. Multidisciplinary collaboration is critical for prompt diagnosis and tailored management to improve maternal-fetal outcomes. CASE REPORT We present a case of a 28-year-old pregnant woman with a history of gestational diabetes mellitus who developed DKA and HTG-AP at 32 weeks 4 days of gestation, necessitating an emergency cesarean section. A multidisciplinary team implemented a joint management protocol for DKA and HTG-AP, including rapid fluid resuscitation, insulin infusion for glycemic control, electrolyte correction, and emergency cesarean section. Anesthesia management comprised general anesthesia with endotracheal intubation combined with transversus abdominis plane block, along with dynamic monitoring of acid-base homeostasis through serial intraoperative arterial blood gas analyses (n=5). The neonate exhibited significant improvement in Apgar scores following resuscitation, while the mother was transferred to the ICU postoperatively and achieved full recovery after 8 days of comprehensive treatment. CONCLUSIONS This case shows that DKA and HTG-AP during pregnancy constitute critical conditions requiring multidisciplinary collaboration to enable rapid diagnosis, personalized interventions, and precise anesthesia management, all of which are pivotal determinants of improved prognosis.