Abstract
BackgroundEuglycaemic 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 presentationsWe 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.ConclusionWe discuss possible physiology and propose a management strategy for euglycaemic ketoacidosis in pregnancy.
Highlights
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
COVID-19 in pregnancy is associated with more severe illness, higher rates of admission to intensive care, and higher mortality than in the non-pregnant population [3, 4]
COVID‐19 infection is associated with ketosis or ketoacidosis in 6.4% of patients requiring hospitalisation, with 35% of these patients affected by diabetes [10]
Summary
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. COVID-19 in pregnancy is associated with more severe illness, higher rates of admission to intensive care, and higher mortality than in the non-pregnant population [3, 4]. Pre-existing diabetes mellitus is associated with increased COVID-19 disease severity and mortality [6, 7].
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