A case series of euglycemic starvation ketoacidosis in pregnant women with COVID-19 infection: atypical presentations

Abstract

Background: We present a case series of euglycemic starvation ketoacidosis in pregnant women with coronavirus disease 2019 (COVID-19) infection. Our patients presented with fever and typical respiratory symptoms secondary to COVID-19 infection in the third trimester. It was complicated by severe metabolic ketoacidosis, likely contributed by the hypermetabolic state of pregnancy, maternal starvation, and increased metabolic demand due to COVID-19 infection. Case Presentation: Among most of the cases, there was a swift resolution of ketoacidosis, through timely fluid resuscitation, dextrose, and insulin. But despite those measures, most of the patients had to undergo emergency cesarean section due to maternal deterioration, preterm delivery, and fetal distress. All the mothers recovered well and were discharged home, but there was one case of neonatal death after preterm delivery. Conclusion: These cases illustrate the importance of early diagnosis of euglycemic ketoacidosis, prompt management, and close monitoring to obviate adverse materno-fetal outcomes in pregnant women with COVID-19 infection.