Lactation Ketoacidosis: A Systematic Review of Case Reports

Abstract

Background and Objective: Lactation ketoacidosis is a rare cause of high anion gap metabolic acidosis affecting breastfeeding mothers. We aim to review and analyze all cases of lactation ketoacidosis reported. Materials and Methods: A systematic search of PubMed/MEDLINE and Cumulative Index to Nursing and Allied Health Literature (CINAHL), identifying relevant case reports published from 1 January 1970 to 31 December 2019. We extracted the following data: the first author, country, year of publication, age of the mother, age of the child, weight/body mass index (BMI) of the mother, precipitating factors, presenting symptoms, biochemical results, treatment, breastfeeding, and time from presentation to the resolution of ketoacidosis. Results: Sixteen case reports and 1 case series reporting 18 cases of lactation ketoacidosis were found. Presenting symptoms were nausea (72%, 13/18), vomiting (67%, 12/18), malaise (56%, 10/18), abdominal pain (44%, 8/18), dyspnea (33%, 6/18), headache (22%, 4/18), and palpitation (11%, 2/18). Dieting and physical exercise to lose weight were reported in 76% (14/18). The treatments included IV dextrose, sodium bicarbonate, insulin, rehydration, monitoring and replacement of electrolytes, and resumption of a balanced diet. The prognoses were good, with no mortalities. Conclusions: lactation ketoacidosis should be suspected in unwell breastfeeding women with high anion gap metabolic acidosis, after excluding other causes.

Lactation Ketoacidosis in a COVID- 19 patient: A Case Report

“…Ketoacidosis has been reported to be induced by a low carbohydrate diet [5]. A negative energy balance due to any stressor exacerbates ketogenesis; thus, a stressor such as breastfeeding can produce lactation ketoacidosis [6].…”

Severe lactation ketoacidosis presenting as a respiratory complaint

“…In the veterinary literature this has been well described as “bovine ketosis.” 3 The literature on this condition in humans is limited mainly to case reports, the first of which was published in 1982. 4 A recent systematic review by Al Alawi identified only 18 published cases globally over the last 30 years 2 . We report a case of severe LKA that was identified in a young postpartum patient who presented with common chief complaints.…”

“…4 A recent systematic review by Al Alawi identified only 18 published cases globally over the last 30 years. 2 We report a case of severe LKA that was identified in a young postpartum patient who presented with common chief complaints. A venous blood gas revealed a pH of 7.0, pCO2 of 19 consistent with metabolic acidosis with appropriate respiratory compensation.…”

“…JACEP Open published by Wiley Periodicals LLC on behalf of American College of Emergency Physicians demands of breastfeeding are not met with adequate carbohydrate consumption, resulting in a relative starvation state in the absence of fasting. 2,4 LKA was first noted in lactating dairy cows whose energy requirements for milk production and maintenance would increase faster than their energy intake via feeds in the first 6 to 8 weeks of lactation. In the veterinary literature this has been well described as "bovine ketosis."…”

“…However, there is a rare and often unconsidered form of ketoacidosis that occurs in the absence of a clear history of one of these risk factors. Lactation ketoacidosis (LKA) is a form of starvation ketoacidosis that can occur in lactating women if the metabolic demands of breastfeeding are not met with adequate carbohydrate consumption, resulting in a relative starvation state in the absence of fasting 2,4 …”