Delayed Diagnosis of Diabetic Ketoacidosis During Pregnancy
Patients with diabetes are very capable of healthy pregnancies and delivering thriving babies. But complications of diabetes during pregnancy can happen. When they do, obstetricians and nurses need to recognize the signs and act fast.
Diabetic ketoacidosis in pregnancy is a serious medical condition which can threaten the life of the pregnant patient and the fetus. Obstetricians and nurses who care for pregnant patients need to recognize signs of diabetic ketoacidosis, confirm the diagnosis, and provide timely treatment to assure the health of the patient and fetus.
When evaluating whether a doctor or nurse wrongly delayed the diagnosis of diabetic ketoacidosis in pregnancy, we start with the medical records. Like other cases where delays in diagnosis harm patients, the lawyers of Lupetin & Unatin, LLC look for clues primarily in three areas of the medical records:
- The patient’s recent medical history;
- The patient’s symptoms
- Laboratory test results
Sometimes doctors and nurses fail to heed red flags which point to diabetic ketoacidosis in pregnancy. Often, the patient’s history is the first and most obvious red flag. Two common triggers for diabetic ketoacidosis are discontinuation of diabetic medications and underlying infection. If the history is related to either of these issues, the evaluating health care provider should immediately consider diabetic ketoacidosis.
Unfortunately, typical symptoms of pregnancy like nausea, vomiting, or abdominal pain distract doctors from the diagnosis of diabetic ketoacidosis. Symptoms like these are common in diabetic ketoacidosis during pregnancy, but could also be associated with infection or sickness during the first and second trimesters of pregnancy. Nevertheless, physicians should not presume a diabetic patient is suffering from an illness of pregnancy which will pass without causing harm. When a patient’s symptoms and history raise concern for diabetic ketoacidosis in pregnancy, a doctor must rule-out this threat before attributing the symptoms to a less serious medical condition.
Doctors and nurses cannot lose sight of the fact that diabetic ketoacidosis in a pregnant patient is an obstetrical emergency. Specific steps can help confirm or exclude the diagnosis. To protect the patient and the fetus, obstetrical providers must:
- Perform relevant lab tests for the pregnant patient – The failure to order appropriate laboratory testing of blood and urine can delay diagnosis or treatment of diabetic ketoacidosis. Key lab tests include urinalysis, urine culture, blood glucose, and a blood test called a complete metabolic panel. Without these tests, doctors cannot determine whether the pregnant patient has a life-threating condition called metabolic acidosis. Metabolic acidosis goes hand in hand with diabetic acidosis and can range from mild to severe. Metabolic acidosis in a pregnant patient can cause organ failure or death. And the harmful effects of acidosis can pass to the fetus as well.
- Monitor the well–being of the fetus – Obstetrical doctors and nurses may be liable for medical malpractice if they neglect the well-being of the fetus in a patient who has diabetic ketoacidosis. Doctors and nurses must continuously monitor the fetal heart rate and the pregnant patient’s contractions. Also, the obstetrician may need to order a test called a biophysical profile. A biophysical profile is performed with ultrasound and can reveal early warning signs of a fetus under stress from the harmful effects of diabetic ketoacidosis.
- Treat the cause of diabetic ketoacidosis in pregnancy and stabilize the patient – Fortunately, doctors can treat diabetic ketoacidosis in pregnancy before it causes permanent harm to the pregnant patient or their baby. IV fluids and insulin are the mainstays of treatment. But it is not enough to start treatment and presume everything will be OK. A pregnant patient should remain hospitalized and receive intensive treatment and monitoring by specialists trained to address this emergency condition.
- Repeat blood tests – A doctor should never send a pregnant patient with diabetic ketoacidosis home from the hospital until their symptoms resolve and there is no sign of metabolic acidosis. Prematurely sending a patient home without performing repeat lab work to confirm the patient is stable is beneath the standard of medical care patients deserve.
When diabetic ketoacidosis in pregnancy leads to the tragic loss of a child, the lawyers of Lupetin & Unatin, LLC can help. We will obtain all the important medical records. We can help families understand why this happened and uncover medical errors related to issues such as:
- Lack of communication between nurses and doctors;
- Failure to perform an appropriate medical history;
- Failure to perform proper laboratory tests for the pregnant patient;
- Failure to perform proper monitoring and testing of the fetus, and if necessary, arrange for earlier delivery of the baby;
- Failing to fully treat a patient for diabetic ketoacidosis in pregnancy before discharging the patient and their fetus to home.
If you or a loved one would like to learn more, we invite you to reach out to the Pittsburgh medical malpractice attorneys of Lupetin & Unatin. We are experienced birth injury attorneys who can help you find the answers to the most difficult and upsetting questions a family should ever need to ask.