Ketoacidosis occurring during lactation has been described infrequently. The condition is incompletely understood, but it appears to be associated with a combination of increased metabolic demands during lactation, reduction in carbohydrate intake and acute illness. We present a case of a 27-year-old woman, 8 weeks post-partum, who was exclusively breastfeeding her child whilst following a low carbohydrate diet. She developed gastroenteritis and was unable to tolerate an oral diet for several days. She presented with severe metabolic acidosis on admission with a blood 3-hydroxybutyrate of 5.4 mmol/L. She was treated with intravenous dextrose and intravenous sodium bicarbonate, and given dietary advice to increase her carbohydrate intake. She made a rapid and full recovery. We provide a summary of the common causes of ketoacidosis and compare our case with other presentations of lactation ketoacidosis.Learning points:Ketoacidosis in the lactating woman is a rare cause of raised anion gap metabolic acidosis.Low carbohydrate intake, starvation, intercurrent illness or a combination of these factors could put breastfeeding women at risk of ketoacidosis.Ketoacidosis in the lactating woman has been shown to resolve rapidly with sufficient carbohydrate intake and intravenous dextrose.Early diagnosis and prompt treatment are essential because the condition is reported to be reversible with a low chance of recurrence with appropriate dietary advice.

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Background & objective: This prospective study was undertaken to determine the role of Depomedroxy progesterone acetate (DMPA) in the management of abnormal uterine bleeding associated with norplant use. Methods: The study was carried out in the Department of Family Planning Model Clinic of Sir Salimullah Medical College and Mitford Hospital, Dhaka between June, 2003 to December, 2005. A total 54 clients were consecutively selected, based on predefined enrolment criteria. Results: Over two-thirds (70.6%) of the patients were multipara (2-3 live births), 22% primipara and the rest 7.4% grand-multipara (4 or more live births). Among 54 cases, 45(84%) responded to treatment. Of the 9 (16%) cases who failed to respond to DMPA treatment, 4 cases were given 2nd dose of DMPA. Three cases dropped out after failing the 1st dose and 2 cases refused to receive 2nd dose and their norplant was removed on request. Abnormal per vaginal (P/V) bleeding began from the 1st month of insertion of Norplant with 15 (27.7%) cases in the 1st month, 7(12%) cases between 2nd to 5th months, 16(28%) cases between 6-12 months, 11(20%) between 13-24 months and 5 (9.3%) cases between 25-36 months. Conclusion: The study showed that DMPA is a simple and effective modality of treatment for women with abnormal or irregular uterine bleeding associated with norplant implant use. With increased compliance from clients’ perspective, it could be a good option for treatment of women with abnormal or irregular uterine bleeding caused by norplant implant. Ibrahim Card Med J 2017; 7 (1&2): 80-83