Euglycaemic ketoacidosis in pregnant women with COVID-19: two case reports
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Author(s)
Type
Journal Article
Abstract
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.
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.
Date Issued
2021-06-16
Date Acceptance
2021-06-04
Citation
BMC Pregnancy and Childbirth, 2021, 21
ISSN
1471-2393
Publisher
BioMed Central
Journal / Book Title
BMC Pregnancy and Childbirth
Volume
21
Copyright Statement
© The Author(s) 2021.This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
License URL
Subjects
COVID-19
EKA
Euglycaemic
Ketoacidosis
Pregnancy
COVID-19
Female
Fluid Therapy
Humans
Insulin Resistance
Ketosis
Maternal-Fetal Exchange
Pregnancy
Pregnancy Complications
SARS-CoV-2
Starvation
Humans
Pregnancy Complications
Ketosis
Insulin Resistance
Starvation
Fluid Therapy
Pregnancy
Maternal-Fetal Exchange
Female
COVID-19
SARS-CoV-2
Obstetrics & Reproductive Medicine
1110 Nursing
1114 Paediatrics and Reproductive Medicine
1117 Public Health and Health Services
Publication Status
Published
Article Number
ARTN 427