Clinical Expert Series
Diabetic Ketoacidosis in Pregnancy
Baha M. Sibai, MD, and Oscar A. Viteri, MD
Obstet Gynecol 2014;123(1)
Continuing Medical Education credit is provided through joint sponsorship with
The American College of Obstetricians and Gynecologists.
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Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
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Category 1 Credits.™ Physicians should claim only the credit commensurate with the extent of their participation in the activity.
College Cognate Credit(s)
The American College of Obstetricians and Gynecologists designates this enduring material for a maximum of 2 Category 1
College Cognate Credits. The College has a reciprocity agreement with the AMA that allows AMA PRA Category 1 Credits™ to be
equivalent to College Cognate Credits.
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control of any commercial interest. All authors, reviewers, and contributors have disclosed to the College all relevant financial
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Submission
Before submitting this form, please print a completed copy as confirmation of your program participation.
College Fellows: To obtain credits, complete and return this form by e-mail (obgyn@greenjournal.org) or fax (202-479-0830).
Your score, and a copy of the answer key, will be e-mailed to you after receipt of a completed quiz. Credit will be recorded for
those participants answering 80–100% of questions correctly. Online transcripts will be updated twice monthly. College Fellows
may check their transcripts online at http://www.acog.org. Please direct questions to the Obstetrics & Gynecology Editorial
Office, 202-314-2317 (phone) or obgyn@greenjournal.org (e-mail).
Non–College Fellows: To obtain credits, submit the printout of the completed quiz to your accrediting institution. The printout of
the completed quiz is documentation for your continuing medical education credits.
Continuing medical education credit for “Diabetic Ketoacidosis in Pregnancy” will be available through January 2017.
1. Ketoacidosis during pregnancy differs from that seen in nonpregnant patients by virtue of it being:
Slower in progression of symptoms
Found at lower glucose levels
Associated with lower morbidity rates
Associated with renal failure
Treatable as an outpatient
CME Quiz for the Clinical Expert Series
Obstet Gynecol 2014;123(1)
Credit available through January 2017
Page 1 of 3
2. Potential precipitating factors for ketoacidosis during pregnancy include:
Insulin overdose
Steroid administration for fetal lung maturation
Minimal or any alcohol consumption
Multiparity
Use of oral hypoglycemic agents
3. Initial correction of hyperglycemia during an acute episode of diabetic ketoacidosis in pregnancy is
best achieved with:
Intravenous NPH insulin
Intravenous Lantus insulin
Intravenous regular insulin
Subcutaneous regular insulin
Oral metformin
4. The pregnancy-related hormone most closely associated with reduced cellular sensitivity to insulin is:
Human chorionic gonadotropin (HCG)
Human placental lactogen (HPL)
Progesterone
Insulin-like growth factor
Human growth hormone (HGH)
5. During maternal diabetic ketoacidosis, fetal arrhythmias are thought to occur because of:
Decreased oxygen release from the red blood cells
Hypokalemia
Respiratory alkalosis
Fetal hypervolemia
Hypophosphatemia
6.
The administration of corticosteroids for fetal lung maturation will result in acute elevations in serum
glucose that can last up to:
6 hours
12 hours
24 hours
3 days
5 days
CME Quiz for the Clinical Expert Series
Obstet Gynecol 2014;123(1)
Credit available through January 2017
Page 2 of 3
7. The most important factor in correctly diagnosing diabetic ketoacidosis in pregnancy is:
Frequent blood glucose measurements
A high level of suspicion
Level of maternal hemoglobin A1c
Presence of urinary ketone bodies
Urine osmolality
8. Initial fluid replacement for a pregnant patient with diabetic ketoacidosis should be approximately:
1 mL/kg of body weight
10 mL/kg of body weight
100 mL/kg of body weight
1 L/kg of body weight
2 L/kg of body weight
9. During the fluid resuscitation of a pregnant diabetic patient with ketoacidosis, it is appropriate to use
intravenous solutions containing 5% glucose after the patient’s serum glucose is below:
50 mg/dL
100 mg/dL
150 mg/dL
250 mg/dL
350 mg/dL
10. Most complications from diabetic ketoacidosis in pregnancy result from:
Prematurity
Inadequate fluid management
Insulin overuse
Maternal age
Hypophosphatemia
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CME Quiz for the Clinical Expert Series
Obstet Gynecol 2014;123(1)
Credit available through January 2017
Page 3 of 3