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Abstract: FR-PO859

Acute Starvation Ketoacidosis in Pregnancy: Too Fast, Too Furious

Session Information

Category: Women's Health and Kidney Diseases

  • 2200 Women's Health and Kidney Diseases


  • Patel, Neev, LSU Health Shreveport, Shreveport, Louisiana, United States
  • Pethani, Yashvi, LSU Health Shreveport, Shreveport, Louisiana, United States
  • Khan, Maheen, LSU Health Shreveport, Shreveport, Louisiana, United States
  • Adisa, Oluwadamilola, LSU Health Shreveport, Shreveport, Louisiana, United States
  • Sequeira, Adrian P., LSU Health Shreveport, Shreveport, Louisiana, United States

Starvation ketoacidosis in pregnancy is rare and potentially lethal. Maternal mortality rates up to 35% and fetal mortality rates up to 85% have been reported. Moreover, maternal acidosis is associated with detrimental fetal neural development. Majority of previously reported cases were in setting of pre-existing diabetes mellitus and required emergent caesarean section. This case demonstrates a distinctive presentation characterized by severe ketoacidosis in the context of acute starvation, absence of diabetes, and positive fetomaternal outcomes.

Case Description

26-year-old female G4P2103 at 35 weeks of gestation with history of anemia presented to labor unit with intractable vomiting for around 24 hours. Further history was significant for acetaminophen use for a month. Vitals were significant for pulse 115/min, respiratory rate 20/min, BP 106/63 mm Hg. Blood chemistry showed CO2 9 mmol/L, glucose 61 mg/dL, and anion gap 19. Urinalysis showed specific gravity > 1.030, protein > 300 mg/dL, ketones > 160 mg/dL. On arterial blood gas, pH was 7.184, PCO2 31 mm Hg, and a base deficit –16 mmol/L.

Blood lactate, ethanol, methanol, and acetaminophen levels were normal. Beta hydroxy butyrate was 52.29 mg/dL. Diabetic ketoacidosis was ruled out based on glucose 61 mg/dL and hemoglobin A1c 4.8%. Diagnosis of starvation ketoacidosis was made.

She was treated with intravenous sodium bicarbonate and dextrose infusion for around 24 hours, with improvement in metabolic acidosis. No fetomaternal complications occurred.


In healthy individuals, it takes a minimum of 14 days for starvation to reach its peak severity, characterized by a pH value typically above 7.3 while in pregnancy, starvation ketosis can develop within a few days. In pregnancy, heightened levels of estrogen, progesterone, and human placental lactogen cause insulin resistance, hindering cellular glucose uptake. Consequently, increased lipolysis and free fatty acids lead to ketosis. Management primarily includes bicarbonate and dextrose infusion along with fetal monitoring. Insulin does not play a role in starvation ketoacidosis as opposed to diabetic ketoacidosis.