Emesis and the tendency for early lipolysis following relatively short episodes of fasting (accelerated starvation of pregnancy), result in ketonuria being found in a significant number of healthy pregnant women. Therefore, for a diagnosis of DKA in pregnancy, ketonaemia or academia (pH < 7.3 or serum bicarbonate < 15mmol/L ) should be demonstrated. DKA is associated with poor uteroplacental blood flow and fetal acidosis, which is reflected on cardiotocography. As fetal acidosis reverses with satisfactory treatment of DKA, emergency delivery should not be planned in the presence of an abnormal CTG in this setting. DKA is a medical emergency and should be managed in intensive care setting. The management is similar to that of a non-pregnant adult with DKA.