Abstract
Acute starvation was found as the single probable triggering cause for this condition, since most-common causes of high-anion gap metabolic acidosis were dismissed. We report the case of a 34-year-old woman undergoing a 25-weeks pregnancy and suffering COVID-19 severe pneumonia who developed severe and persistent metabolic acidemia caused by non-diabetic ketoacidosis in whom we found a background of 48-hours starvation prior to ICU admission. The patient underwent 13-days mechanical ventilation and comprehensive care as well as an addressed treatment for this complication. Further the metabolic acidosis got solved and lately we were able to discharge her from the ICU and, ultimately, from hospital to home with the only need of supplementary oxygen. Ketosis is common in prolonged fasting, but it rarely impacts pH in an acute patient. In conditions of increased metabolic demand, such as pregnancy and pneumonia, starving could increase metabolic stress and finally alter the acid-base status affecting the clinical situation for the patient.
Highlights
Starvation ketoacidosis rarely occurs in non-diabetic patients as there are glucose-production pathways compensating for the lack of carbohydrates intake
We report the case of a 34-year-old woman undergoing a 25-weeks pregnancy and suffering COVID-19 severe pneumonia who developed severe and persistent metabolic acidemia caused by non-diabetic ketoacidosis in whom we found a background of 48hours starvation prior to ICU admission
We found a clinical for depression, her caloric intake decreased, and high anion gap metabolic acidosis arose once again
Summary
Starvation ketoacidosis rarely occurs in non-diabetic patients as there are glucose-production pathways compensating for the lack of carbohydrates intake.
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