Lactation ketoacidosis: an easily missed diagnosis

Azzam, Omar; Prentice, David

doi:10.1111/imj.14207

Cited by 13 publications

(11 citation statements)

References 14 publications

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“…In the end, 17 articles, 16 case reports, and 1 case series reporting on 18 patients with lactation ketoacidosis were included ( Table 2 and Table 3 ) [ 4 , 5 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 ]. All of these case reports and case series met the criteria for good quality.…”

Section: Resultsmentioning

confidence: 99%

“…Breastfeeding of two babies simultaneously was thought to be a contributing factor for lactation ketoacidosis in two cases [ 10 , 21 ]. Other precipitating factors were gastroenteritis [ 18 , 19 ], severe gastroesophageal reflux, prolonged preoperative fasting [ 12 ], significant weight loss after gastric banding surgery [ 14 ], and urinary tract infection [ 4 ].…”

Section: Resultsmentioning

confidence: 99%

“…Intravenous (IV) dextrose was the primary treatment in 89% (16/18) of the patients ( Table 2 ). IV sodium bicarbonate was administered in 44% (8/18) of the patients ( Table 1 ) [ 9 , 11 , 12 , 13 , 14 , 18 , 19 , 20 ]. The patients with severe acidosis, i.e., lower pH, were more likely to be given IV sodium bicarbonate.…”

Section: Resultsmentioning

confidence: 99%

“…Additionally, serum osmolality, drug, and alcohol screening should be considered when there is suspicion of abuse. Screening for infection should be carried out if the history or clinical examination is suggestive of an infective process being the precipitating factor [ 19 ]. Based on our experience and the current systematic review, we suggest that certain criteria, listed in Table 4 , should be fulfilled before diagnosing lactation ketoacidosis.…”

Section: Discussionmentioning

confidence: 99%

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Lactation Ketoacidosis: A Systematic Review of Case Reports

2020

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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.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Lactation Ketoacidosis: A Systematic Review of Case Reports

2020

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“…Ketoacidosis may occur in pregnant women with normal glucose tolerance after as little as 16 h of starvation . Ketoacidosis has also been described in lactating women on low carbohydrate diets or while fasting . Starvation ketoacidosis has also been reported following bariatric surgery, with fruitarian and ketogenic diets, and the use of artificial sweeteners such as aspartame.…”

Section: Methodsmentioning

confidence: 99%

Review article: Ketoacidosis in the emergency department

Morton

2020

Emerg Medicine Australasia

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Diabetic ketoacidosis, a life‐threatening complication of type 1 diabetes mellitus, is a common cause of presentation to EDs. Two new drug classes have been found to cause ketoacidosis with distinctive presentations. The sodium‐glucose transport protein 2 inhibitors used in the management of type 2 diabetes mellitus may present with ketoacidosis with normal glucose levels. Ketoacidosis with these medications may be prolonged and recur after initial resolution. Checkpoint inhibitors may present with fulminant diabetic ketoacidosis in individuals with previously normal glucose tolerance. Ketoacidosis may also occur as a result of starvation and alcohol excess, as well as a number of rare causes. Other causes of metabolic acidosis with both high and normal anion gap need to be considered in the differential diagnosis of ketoacidosis. Diabetic ketoacidosis may also present with biochemical changes suggestive of myocardial ischaemia and pancreatitis in the absence of these pathologies. The present paper reviews ketone body metabolism, ketone testing and the causes and differential diagnosis of ketoacidosis with particular relevance to emergency medicine.

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Eu- or hypoglycemic ketosis and ketoacidosis in children: a review

et al. 2023

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The last decade has been characterized by exciting findings on eu- or hypoglycemic ketosis and ketoacidosis. This review emphasizes the following five key points: 1. Since the traditional nitroprusside-glycine dipstick test for urinary ketones is often falsely negative, the blood determination of β-hydroxybutyrate, the predominant ketone body, is currently advised for a comprehensive assessment of ketone body status; 2. Fasting and infections predispose to relevant ketosis and ketoacidosis especially in newborns, infants, children 7 years or less of age, and pregnant, parturient, or lactating women; 3. Several forms of carbohydrate restriction (typically less than 20% of the daily caloric intake) are employed to induce ketosis. These ketogenic diets have achieved great interest as antiepileptic treatment, in the management of excessive body weight, diabetes mellitus, and in sport training; 4. Intermittent fasting is more and more popular because it might benefit against cardiovascular diseases, cancers, neurologic disorders, and aging; 5. Gliflozins, a new group of oral antidiabetics inhibiting the renal sodium-glucose transporter 2, are an emerging cause of eu- or hypoglycemic ketosis and ketoacidosis. In conclusion, the role of ketone bodies is increasingly recognized in several clinical conditions. In the context of acid–base balance evaluation, it is advisable to routinely integrate both the assessment of lactic acid and β-hydroxybutyrate.

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Lactation ketoacidosis: an easily missed diagnosis

Cited by 13 publications

References 14 publications

Lactation Ketoacidosis: A Systematic Review of Case Reports

Lactation Ketoacidosis: A Systematic Review of Case Reports

Review article: Ketoacidosis in the emergency department

Eu- or hypoglycemic ketosis and ketoacidosis in children: a review

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