Starvation Ketosis Versus Euglycemic Diabetic Ketoacidosis in Pregnancy: A Case Report Highlighting the Diagnostic...

Starvation ketosis in pregnancy, though rare, is increasingly recognized, underscoring the need for a better understanding of its pathophysiology. Prolonged fasting or inadequate carbohydrate intake leads to elevated ketone levels, which can adversely affect maternal and fetal health. Early diagnosis via ketone monitoring and clinical assessments, is essential. The clinical presentation and laboratory profile of starvation ketosis overlap with euglycemic diabetic ketoacidosis (DKA), often creating a diagnostic dilemma.

A 28-year-old female with gestational diabetes presented at 37 weeks of gestation with a 3-day history of nausea, vomiting, and abdominal pain. She had been unable to eat for 60 hours, consuming only small sips of water. Laboratory workup revealed high-anion gap metabolic acidosis with elevated β-hydroxybutyrate. Other causes of high-anion gap metabolic acidosis were ruled out, leading to a diagnosis of starvation ketosis versus euglycemic DKA. The patient was treated with dextrose supplementation to meet caloric needs, along with an insulin infusion. As her nausea improved, she tolerated an oral diet and was gradually weaned off intravenous dextrose. She recovered well and delivered a healthy infant at 38 weeks of gestation via spontaneous vaginal delivery.

During starvation, the body transitions from glucose to lipid metabolism, producing ketone bodies as an alternative energy source. While ketoacidosis typically develops after 10 to 14 days in nonpregnant individuals, pregnancy-induced insulin resistance increases susceptibility, allowing ketoacidosis to develop within 24 hours, particularly in the third trimester.

Treatment of starvation ketosis in pregnancy involves aggressive caloric replacement through dextrose infusions and insulin supplementation. Early intervention and maintaining a high index of clinical suspicion are crucial to prevent adverse complications for both mother and fetus.