Pregnancy and ketoacidosis: Is pancreatitis a missing link?

Frise, Charlotte; Ashcroft, Anna; Jones, B.; Mackillop, Lucy

doi:10.1177/1753495x15612330

Cited by 10 publications

(6 citation statements)

References 25 publications

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“…In addition, underlying causes of gastrointestinal symptoms, such as pancreatitis, contribute to nondiabetic ketoacidosis in pregnancy and thus should be identified and treated if possible. [ 17 ] Issues similar to nondiabetic ketoacidosis have also been noted for lactating women on ketogenic diets, which are low-carbohydrate and high-fat diets, or those who experience starvation. [ 18 , 19 ] Clinicians should be aware of these associated risks in high-risk patients.…”

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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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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“…Several cases of pancreatitis have been associated with non‐DKA in pregnant and non‐pregnant individuals, the authors postulating that ketoacidosis was not because of starvation alone, but the promotion of ketogenesis by high levels of lipase, as well as elevated counter‐regulatory hormones to insulin …”

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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“…The obstetrician considers many obstetric and medical factors while planning the delivery in a woman with GDM.In general, waiting at least until 38 completed weeks' gestation improves fetal outcome, especially in diabetic patients (61) .However, if an indication for early delivery exists, GDM should not be considered as a contraindication to proceed with interventionsfor early delivery. Also, if a spontaneous preterm delivery seems imminent, it should not be postponed (62) At times, in fact, an early, planned operative delivery may be appropriate for women with ketosis or ketoacidosis, difficult-to-control diabetes, with frequent episodes of hypoglycemia or hyperglycemia, excessively high insulin requirements, or any other clinical situation which may put the fetus at risk.This may also be true for women with compromised cardiovascular, renal, or retinal function (63) .Macrosomia refers to a baby who is considerably larger than normal. All of the nutrients the fetus receives come directly from the mother's blood.…”

Section: Factors Influencing Timing Of Delivery In Gdm: Biomedical Famentioning

confidence: 99%

Impact of Gestational Diabetes Mellitus on Child Birth

C.J¹,

Jose²,

Venkateswaramurthy³

et al. 2020

IJAR

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GestationalDiabetesMellitus(GDM) is an irregular glucose tolerance condition that developsfirst and is recognized during pregnancy.The Oral Glucose Tolerance Test (OGTT) is the gold standard for the diagnosis of this disorder from 24 to 28 weeks. A number of adverse results, including gestational hypertension, cardiovascular disease and preeclampsia, havebeen associated with pregnant women. As for maternal glucose levels in the second or third trimester the risk of adverse outcomes drastically increases, even within ranges previously considered normal for pregnancy. Excessive gestational weight gain in women with GDM, it is very normal and closely correlated with lifestyle factors during pregnancy. High fat consumption particularly saturated fat, trans fat and cholesterol, increases GDM risk. A higher intake of added sugar and lower intake of vegetable and fruit fiber are independently linked to increased fasting glucose. Animal protein consumption is positive and vegetable protein is inversely related to the risk of GDM.Since fetuses and infants are particularly vulnerable to the effects of toxic compounds, attempts should be made during the years well before childbearing to reduce the exposure of girls and women to dioxins in food, so that fewer quantities of these compounds accumulate in their bodies and are passed on through the placenta and breast milk.The key sources of exposure for most people are fats in meat, food, fatty fish, whole milk and full-fat milk products and their intake should be reduced.

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Pregnancy and ketoacidosis: Is pancreatitis a missing link?

Cited by 10 publications

References 25 publications

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

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

Review article: Ketoacidosis in the emergency department

Impact of Gestational Diabetes Mellitus on Child Birth

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