It is reported in the chronological sequence in which it was presented.
Obstetric Emergency Department, San Juan de Dios Hospital.
39-year-old pregnant, morbidly obese (Body Mass Index 44.8 kg/m2), with 32 + 2 weeks of gestation, consulting for presenting hyperemesis of 10 days of increasing diarrhea and intermittent onset.
At the first obstetric check-up, at 14 weeks of gestation, a fasting blood glucose was recorded: 225 mg/dl. At week 31, an oral glucose tolerance test (OGTT) was performed and an extra 60 mg/dl blood glucose test was performed.
Family history: mother DM2, hypertensive.
People: do not smoke, do not drink alcohol, do not use drugs.
Do not take medicines.
Obstetric: a delivery, non-macrosomal child, no abortion, has not presented GD.
Physical admission.
His blood pressure was 184/115 mmHg, he had a fever, Glasgow 15, without edema, good distal perfusion, mild stenosis, and signs of acanthosis nigricans.
Cardiopulmonary and abdominal examinations were normal.
The patient was gravidarum with normal tone and height 35 cm. Neurological evaluation: normal osteotendinous reflexes without motor deficit.
Blood glucose at admission 120 mg/dl.
Maternity leave
She was hospitalized with a diagnosis of Hyperbilirubic Syndrome Pregnancy (HSS), GD, morbid obesity and pregnancy with poor prenatal control.
Treatment plan: blood pressure monitoring and control, EHS study and evaluation of the placental fetus unit: perception of fetal movements (+), non-stressful basal recording (NSRB) performed non-reactive, fetal betamethasone 12/8.
Elevated liver function tests showed normal blood pressure levels, so the diagnosis of HES is ruled out, but it continues with frequent vomiting.
Critical patient unit
Internist diagnosed: Diabetes Pregest (DPG) with Diabetic ketoacidosis.
He was given normal saline (100 ml/h), capillary glycemia every 30 min fluctuated 18099 mg/dl regular insulin sc according to glycemia: 150-199 mg/dl, 2 U insulin; 200-249 mg/dl capillary glucose levels 4 U; 250-299 mg/dl
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The obstetrician suggests resolution of pregnancy quickly; an emergency cesarean section is performed (15 h after admission).
Characteristics of the newborn: weight 2.650 kg, height 46 cm, large for gestational age and Apgar 2.7.
The patient was admitted to the Perinatal Care Unit NICU due to asphyxia, convulsive syndrome and congenital heart disease under study.
Surgical critical patient unit
In the immediate puerperium, the patient is hemodynamically stable, with mild dyspnea, Glasgow 15, metabolic acidosis with increased anion Gap, ketonemia++++.
Glycemia was diagnosed in 172 mg/dl.
Treatment: physiological solution 150 ml/h, glucose 5%, 40 ml/h, insulin microinfusor and bicarbonate supply.
At 12 hours the patient evolved with CD resolution criteria.
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Maternity leave
Evaluated by a diabetes team, NPH insulin was started.
High altitude is indicated as ambulatory control in the Diabetes Unit of San Juan de Dios Hospital.
