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Published on: August 4, 2023
Euglycaemic ketoacidosis in pregnant women with COVID-19: two case reports
Margaret Pikovsky1, Min Yi Tan1, Amanda Ahmed1
1St Mary's Hospital, Obstetrics Department, Imperial College NHS Trust, Praed Street, London, W1 2NY, UK.
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.
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