Euglycemic ketoacidosis in pregnancy and its management: case report and review of literature

Karpate, Shilpaja; Morsi, Hassan; Shehmar, Manjeet; Dale, Jane; Patel, Chandresh

doi:10.1016/j.ejogrb.2013.09.034

Cited by 19 publications

(6 citation statements)

References 8 publications

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“…Starvation ketoacidosis refers to the metabolic acidosis following a period of starvation. Starvation ketoacidosis has been reported rarely in the third trimester due to an exaggerated response to fasting [ 11 , 16 , 17 ].…”

Section: Discussionmentioning

confidence: 99%

Euglycaemic ketoacidosis in pregnant women with COVID-19: two case reports

Pikovsky

Tan

Ahmed

et al. 2021

BMC Pregnancy Childbirth

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Background Euglycaemic ketoacidosis (EKA) is an infrequent but serious condition which usually follows a period of starvation, severe vomiting or illness in individuals with or without diabetes. Ketoacidosis is associated with materno-fetal morbidity and mortality necessitating prompt diagnosis and management. Physiological increases in insulin resistance render pregnancy a diabetogenic state with increased susceptibility to ketosis. COVID-19 is associated with worse clinical outcomes in patients with diabetes and is an independent risk factor for ketoacidosis in normoglycaemic individuals. Case presentations We describe two cases of SARS-CoV-2 positive pregnant women presenting with normoglycaemic metabolic ketoacidosis. Both cases were associated with maternal and fetal compromise, requiring aggressive fluid and insulin resuscitation and early delivery. Conclusion We discuss possible physiology and propose a management strategy for euglycaemic ketoacidosis in pregnancy.

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Section: Discussionmentioning

confidence: 99%

Euglycaemic ketoacidosis in pregnant women with COVID-19: two case reports

Pikovsky

Tan

Ahmed

et al. 2021

BMC Pregnancy Childbirth

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“…A case report and review of literature on this topic published in 2013 found only nine non-diabetic cases of ketoacidosis in pregnant patients from starvation alone. 7 Starvation ketosis outside of pregnancy is rare. Pregnancy has been characterised as a state of accelerated starvation (fasting hypoglycaemia) and a diabetogenic state (postprandial hyperglycaemic).…”

Section: Discussionmentioning

confidence: 99%

Critical COVID-19 in a pregnant patient who presented in starvation ketoacidosis with a background history of acrorenal syndrome

Brady

Aglan

2021

BMJ Case Rep

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A primiparous woman in her late 30s at 28+1 weeks’ gestation presented with a 3-day history of abdominal pain, loss of appetite, nausea and vomiting and was diagnosed with starvation ketoacidosis. A routine admission swab returned positive for COVID-19. She had been diagnosed with acrorenal syndrome from birth. Three days post admission, she deteriorated rapidly into respiratory failure requiring intubation and ventilation. She was treated with dexamethasone, prophylactic enoxaparin, a course of piperacillin/tazobactam followed by meropenem and fluconazole and 8 cycles of proning. An emergency caesarean section was performed on day 12 of hospital admission at 29+5 weeks’ gestation to improve maternal oxygenation and ventilation. The baby had deformities consistent with acrorenal syndrome but no evidence of COVID-19. She spent 23 days in the intensive care unit. Our case describes an unusual presentation of COVID-19, the challenges in managing critically ill pregnant patients along with a rare background history of acrorenal syndrome.

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“…Among the 10 reported nondiabetic starvation ketoacidosis cases, [ 1 – 7 ] only 3 patients [ 5 – 7 ] experienced reversal of severe acidosis after being treated with a 5% or 10% dextrose infusion [ 6 , 7 ] or a fixed-dose insulin regimen, [ 5 ] and most patients required emergency delivery. [ 1 – 4 ] Those 3 cases focused on the ability of endogenous/exogenous insulin to suppress ketoacidosis, although dextrose infusion-related neonatal hyperinsulinemia and subsequent hypoglycemia were concerns.…”

Section: Discussionmentioning

confidence: 99%

Short-term starvation with a near-fatal asthma attack induced ketoacidosis in a nondiabetic pregnant woman

et al. 2016

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Life-threatening refractory metabolic acidosis due to starvation ketoacidosis is rarely reported, even among nondiabetic pregnant women, and may be overlooked. Furthermore, stressful situations may increase the acidosis severity.In the present case, a nondiabetic multiparous woman was admitted for a near-fatal asthma attack and vomiting during the third trimester of pregnancy. She was intubated and rapidly developed high anion gap metabolic acidosis. We diagnosed the patient with starvation ketoacidosis based on vomiting with concomitant periods of stress during pregnancy and the absence of other causes of high anion gap metabolic acidosis. She responded poorly to standard treatment, although the ketoacidosis and asthma promptly resolved after an emergency caesarean section. The patient and her baby were safely discharged.Short-term starvation, if it occurs during periods of stress and medication, can result in life-threatening ketoacidosis, even among nondiabetic women during the third trimester of pregnancy. Awareness of this condition may facilitate prompt recognition and proactive treatment for dietary and stress control, and emergent interventions may also improve outcomes.

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Euglycemic ketoacidosis in pregnancy and its management: case report and review of literature

Cited by 19 publications

References 8 publications

Euglycaemic ketoacidosis in pregnant women with COVID-19: two case reports

Euglycaemic ketoacidosis in pregnant women with COVID-19: two case reports

Critical COVID-19 in a pregnant patient who presented in starvation ketoacidosis with a background history of acrorenal syndrome

Short-term starvation with a near-fatal asthma attack induced ketoacidosis in a nondiabetic pregnant woman

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