Gestational Diabetic Ketoacidosis Complicated by a Probable Postpartum Functional Neurological Disorder Following Severe Preeclampsia and Intrauterine Fetal Demise: A Case Report.

Abstract

Introduction: Gestational diabetic ketoacidosis (GDKA) is a rare but potentially fatal metabolic emergency associated with significant maternal morbidity and a high risk of fetal complications. Although its metabolic and obstetric complications are well described, functional neurological manifestations occurring during the postpartum period remain rarely reported.

Case presentation: We report the case of a 28-year-old primigravida admitted at 34 weeks and 5 days of gestation for gestational diabetic ketoacidosis complicated by severe preeclampsia and intrauterine fetal demise. Management consisted of intensive care including intravenous fluid resuscitation, continuous insulin infusion, correction of electrolyte disturbances, administration of magnesium sulfate, and emergency cesarean delivery. Metabolic evolution was favorable. On postpartum day 4, the patient developed gait instability characterized by an unsteady gait without impaired consciousness or focal neurological deficits. Symptoms disappeared at rest and exhibited contextual variability. Neuropsychiatric and psychological assessments suggested a functional neurological disorder. Complete remission was observed by postpartum day 11.

Discussion: The combination of severe preeclampsia, intrauterine fetal demise, emergency cesarean section, and diabetic ketoacidosis constituted a major psychological stressor that may have contributed to the development of a functional neurological disorder. Although the clinical presentation was highly suggestive of this diagnosis, the absence of brain imaging represents an important limitation of this report.

Conclusion: This case highlights the importance of prompt multidisciplinary management of gestational diabetic ketoacidosis and draws attention to the possibility of functional neurological disorder in patients developing neurological symptoms following severe obstetric complications.