Best Practice & Research Clinical Obstetrics and Gynaecology 28 (2014) e3

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Best Practice & Research Clinical Obstetrics and Gynaecology journal homepage: www.elsevier.com/locate/bpobgyn

Letter to the Editor

Reply to ‘Letter to Editor’ by V. Rosival: Endocrine emergencies in pregnancy Dear Editors 1) We are aware of Rosival’s suggestions that infusion of sodium bicarbonate may be indicated in diabetic ketoacidosis. Established guidelines (referred to in our article) recommend sodium bicarbonate, but only in patients with a pH < 6.9, and this should be used with caution as paradoxical central nervous system acidosis may result, with adverse consequences (see also, Kitabchi AE, Umpierrez GE, Miles JM, Fisher JN. Hyperglycemic crises in adult patients with diabetes. Diabetes Care. 2009 Jul;32(7):1335–43; Savage MW, Dhatariya KK, Kilvert A, Rayman G, Rees JA, Courtney CH, Hilton L, Dyer PH, Hamersley MS. Joint British Diabetes Societies guideline for the management of diabetic ketoacidosis. Diabet Med. 2011 May;28(5):508–15). 2) The use of combined insulin and dextrose infusion is to suppress hepatic synthesis of ketone bodies. Measurement of serum insulin is not relevant in this situation. Chin Meng Khoo, FRCP Ed, Kok Onn Lee, MBBCh, MD (Belfast)* Department of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Level 10, Singapore 119228, Singapore  Corresponding author. Tel.: þ65 67724341; Fax: þ65 68724101. E-mail addresses: [email protected], [email protected] (K.O. Lee)

DOI of original article: http://dx.doi.org/10.1016/j.bpobgyn.2013.08.005. 1521-6934/$ – see front matter Ó 2014 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.bpobgyn.2014.01.003

Reply to 'Letter to Editor' by V. Rosival: Endocrine emergencies in pregnancy.

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