Abstract
Background and Objective: Lactation ketoacidosis is a rare cause of high anion gap metabolic acidosis affecting breastfeeding mothers. We aim to review and analyze all cases of lactation ketoacidosis reported. Materials and Methods: A systematic search of PubMed/MEDLINE and Cumulative Index to Nursing and Allied Health Literature (CINAHL), identifying relevant case reports published from 1 January 1970 to 31 December 2019. We extracted the following data: the first author, country, year of publication, age of the mother, age of the child, weight/body mass index (BMI) of the mother, precipitating factors, presenting symptoms, biochemical results, treatment, breastfeeding, and time from presentation to the resolution of ketoacidosis. Results: Sixteen case reports and 1 case series reporting 18 cases of lactation ketoacidosis were found. Presenting symptoms were nausea (72%, 13/18), vomiting (67%, 12/18), malaise (56%, 10/18), abdominal pain (44%, 8/18), dyspnea (33%, 6/18), headache (22%, 4/18), and palpitation (11%, 2/18). Dieting and physical exercise to lose weight were reported in 76% (14/18). The treatments included IV dextrose, sodium bicarbonate, insulin, rehydration, monitoring and replacement of electrolytes, and resumption of a balanced diet. The prognoses were good, with no mortalities. Conclusions: lactation ketoacidosis should be suspected in unwell breastfeeding women with high anion gap metabolic acidosis, after excluding other causes.
Highlights
Metabolic acidosis is a common medical problem, especially in critically ill patients, and is characterized by low blood pH and serum bicarbonate concentration [1,2]
While epinephrine and glucagon enhance the mobilization of free fatty acid and production of ketone bodies, which can cause high hydrogen load and high anion gap metabolic acidosis, commonly seen in diabetic ketoacidosis but less frequently in starvation and alcoholic ketoacidosis [1,2,3]
17 articles, 16 case reports, and 1 case series reporting on 18 patients with lactation ketoacidosis were included (Tables 2 and 3) [4,5,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22]
Summary
Metabolic acidosis is a common medical problem, especially in critically ill patients, and is characterized by low blood pH and serum bicarbonate concentration [1,2]. Metabolic acidosis can occur as a result of the accumulation of acid (high anion gap metabolic acidosis) or loss of bicarbonate from the kidneys or gastrointestinal tract [1,3]. Common causes of high anion metabolic acidosis include diabetic ketoacidosis, lactate, renal failure, and toxins (e.g., methanol, ethanol, and salicylate) [1]. Urinary tract diversions to the intestine, some types of renal tubular acidosis, and some medications are among the common causes of hyperchloremic or normal anion gap metabolic acidosis [1,2]. Lactation ketoacidosis is a rare cause of high anion gap metabolic acidosis. Lactation ketoacidosis is a rare cause of high anion gap metabolic acidosis affecting breastfeeding mothers. The treatments included IV dextrose, sodium bicarbonate, insulin, rehydration, monitoring and replacement of electrolytes, and resumption of a balanced diet
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
