[Normoglycaemic ketoacidosis in pregnant patients with diabetes; early recognition is critical]. / Normoglykemische ketoacidose bij zwangere diabetici.

Diabetic ketoacidosis (DKA) during pregnancy is a rare but very serious complication that requires early recognition and treatment to prevent severe complications. Here we present three cases in which DKA occurred during normoglycaemia, demonstrating the importance of early recognition. In pregnancy, DKA can occur at lower blood glucose levels than usual due to several pregnancy-related factors, such as altered metabolism, increased insulin resistance, lower buffering capacity related to chronic hyperventilation and hunger. Symptoms that are common during pregnancy, such as vomiting, may be missed as a first sign of DKA. In patients with type 1 diabetes mellitus (especially those on continuous subcutaneous insulin infusion) insulin administration must never be discontinued, as this prevents lipolysis and ketone formation. Physicians and patients need to be aware of the risks and management of DKA in pregnancy.

[Reversible posterior leucoencephalopathy due to hypercalcaemia]. / Reversibele posterieure leuko-encefalopathie bij hypercalciëmie.

A 60-year-old woman presented with changes in behaviour, cognition, cortical blindness and headache. These symptoms were caused by a reversible posterior leucoencephalopathy syndrome due to hypercalcaemia caused by a multiple myeloma, type IgD wavelength. She was treated with isotonic saline and pamidronate; the serum calcium levels normalised and the radiological brain abnormalities disappeared as did the clinical neurological abnormalities. Hypercalcaemia probably affects cerebral perfusion and has direct neurotoxic effects which can lead to cerebral oedema. This case history illustrates a rare cause of a syndrome that can be easily treated and is completely reversible.