Starvation ketoacidosis in pregnancy

Frise, Charlotte; Mackillop, Lucy; Joash, Karen; Williamson, Catherine

doi:10.1016/j.ejogrb.2012.10.005

Cited by 93 publications

(108 citation statements)

References 21 publications

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“…Ketone levels can be checked serially and are more accurate than urine ketone testing, because concentrations of 3-b-hydroxybutyrate are typically 10-fold higher compared with acetoacetate. 64 In response to insulin, 3-b-hydroxybutyrate levels commonly decrease long before acetoacetate levels. 21 …”

Section: Monitoring Of Acidosis and Correction Of Electrolytesmentioning

confidence: 99%

Diabetic Ketoacidosis in Pregnancy

Sibai

Viteri

2014

Obstetrics &Amp; Gynecology

106

112

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Pregnancies complicated by diabetic ketoacidosis are associated with increased rates of perinatal morbidity and mortality. A high index of suspicion is required, because diabetic ketoacidosis onset in pregnancy can be insidious, usually at lower glucose levels, and often progresses more rapidly as compared with nonpregnancy. Morbidity and mortality can be reduced with early detection of precipitating factors (ie, infection, intractable vomiting, inadequate insulin management or inappropriate insulin cessation, β-sympathomimetic use, steroid administration for fetal lung maturation), prompt hospitalization, and targeted therapy with intensive monitoring. A multidisciplinary approach including a maternal-fetal medicine physician, medical endocrinology specialists familiar with the physiologic changes in pregnancy, an obstetric anesthesiologist, and skilled nursing is paramount. Management principles include aggressive volume replacement, initiation of intravenous insulin therapy, correction of acidosis, correction of electrolyte abnormalities and management of precipitating factors, as well as monitoring of maternal-fetal response to treatment. When diabetic ketoacidosis occurs after 24 weeks of gestation, fetal status should be continuously monitored given associated fetal hypoxemia and acidosis. The decision for delivery can be challenging and must be based on gestational age as well as maternal-fetal responses to therapy. The natural inclination is to proceed with emergent delivery for nonreassuring fetal status that is frequently present during the acute episode, but it is imperative to correct the maternal metabolic abnormalities first, because both maternal and fetal conditions will likewise improve. Prevention strategies should include education of diabetic pregnant women about the risks of diabetic ketoacidosis, precipitating factors, and the importance of reporting signs and symptoms in a timely fashion.

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Section: Monitoring Of Acidosis and Correction Of Electrolytesmentioning

confidence: 99%

Diabetic Ketoacidosis in Pregnancy

Sibai

Viteri

2014

Obstetrics &Amp; Gynecology

106

112

View full text Add to dashboard Cite

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“…Beta-hydroxybutyrate and acetoacetate are used as an alternative energy supply but their accumulation results in metabolic acidosis [1]. In an otherwise healthy individual, starvation requires at least 14 days to reach maximum severity, with mildly elevated ketoacids and pH usually being above 7.3 [1, 13]. Sufficient endogenous insulin secretion continues and prevents significant free fatty acid formation.…”

Section: Discussionmentioning

confidence: 99%

“…Sufficient endogenous insulin secretion continues and prevents significant free fatty acid formation. Ketoacidosis is more severe in states of glycogen depletion, as seen in individuals with history of excess alcohol intake, and is augmented by lower insulin levels and perhaps higher levels of counterregulatory hormones as a result of volume depletion [1]. …”

Section: Discussionmentioning

confidence: 99%

“…This is due to placentally derived hormones including glucagon, cortisol, and human placental lactogen which are increased in periods of stress [1]. The insulin resistance increases with gestational age and confers susceptibility to ketosis.…”

Section: Introductionmentioning

confidence: 99%

“…Similar metabolic changes are seen with poor dietary intake or prolonged fasting and resulting acidosis is referred to as “starvation ketoacidosis” [3]. Starvation ketoacidosis is encountered in many settings like prolonged fasting, malnutrition, gastric banding eating disorder, Atkins diet, and alcoholism, but seldom recognized, and is rarely a severe acidosis outside pregnancy [1, 4–7]. …”

Section: Introductionmentioning

confidence: 99%

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Starvation Ketoacidosis: A Cause of Severe Anion Gap Metabolic Acidosis in Pregnancy

Sinha

Venkatram

Diaz‐Fuentes

2014

Case Reports in Critical Care

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Pregnancy is a diabetogenic state characterized by relative insulin resistance, enhanced lipolysis, elevated free fatty acids and increased ketogenesis. In this setting, short period of starvation can precipitate ketoacidosis. This sequence of events is recognized as “accelerated starvation.” Metabolic acidosis during pregnancy may have adverse impact on fetal neural development including impaired intelligence and fetal demise. Short periods of starvation during pregnancy may present as severe anion gap metabolic acidosis (AGMA). We present a 41-year-old female in her 32nd week of pregnancy, admitted with severe AGMA with pH 7.16, anion gap 31, and bicarbonate of 5 mg/dL with normal lactate levels. She was intubated and accepted to medical intensive care unit. Urine and serum acetone were positive. Evaluation for all causes of AGMA was negative. The diagnosis of starvation ketoacidosis was established in absence of other causes of AGMA. Intravenous fluids, dextrose, thiamine, and folic acid were administered with resolution of acidosis, early extubation, and subsequent normal delivery of a healthy baby at full term. Rapid reversal of acidosis and favorable outcome are achieved with early administration of dextrose containing fluids.

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Endocrine and Metabolic Emergencies in Pregnancy

Banerjee

Williamson

2018

Endocrine and Metabolic Medical Emergencies

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Starvation ketoacidosis in pregnancy

Cited by 93 publications

References 21 publications

Diabetic Ketoacidosis in Pregnancy

Diabetic Ketoacidosis in Pregnancy

Starvation Ketoacidosis: A Cause of Severe Anion Gap Metabolic Acidosis in Pregnancy

Endocrine and Metabolic Emergencies in Pregnancy

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