Metabolic Ketoacidosis in a Gravida Diagnosed with COVID-19: A Case Report

Arpita Jaiswal,Dhruv Talwar,Dhruva Halani,Neema Acharya,Sourya Acharya,Sparsh Madaan,Sunil Kumar

doi:10.9734/jpri/2021/v33i45a32750

Abstract

We present a case of term pregnancy which presented with chief complaint of Breathlessness, chest pain as well as a one day history of vomiting. She tested positive for COVID19 through reverse transcriptase polymerase chain reaction of nasopharyngeal swab and the symptoms were attributed to Pneumonia caused due to COVID19.However,the arterial blood gas showed metabolic acidosis with high anion gap. This was a non lactate acidosis with no hypoxemia. Most reasonably the state of pregnancy with increased energy demands along with increased metabolic maternal demand due to infection coupled with maternal starvation had resulted in this Ketoacidosis . In view of non progression of labor caesarian section was carried out and a healthy neonate was delivered. There was an initial improvement in maternal ketoacidosis post partum however optimal management of COVID19 pneumonia required oxygen support and use of corticosteroids. Thus we highlight how an unusual metabolic demands of pregnancy might mimic COVID 19.

Highlights

The virus known as Severe Acute Respiratory Syndrome Coronavirus 2 (SARS CoV 2) and it’s associated disease COVID19 has brought up challenging times for clinicians throughout the world
We present a case of term pregnancy which presented with chief complaint of Breathlessness, chest pain as well as a one day history of vomiting. She tested positive for COVID19 through reverse transcriptase polymerase chain reaction of nasopharyngeal swab and the symptoms were attributed to Pneumonia caused due to COVID19.,the arterial blood gas showed metabolic acidosis with high anion gap
We report a pregnant female with COVID19 manifesting as Metabolic Acidosis which was not associated with diabetes

Summary

INTRODUCTION

The virus known as Severe Acute Respiratory Syndrome Coronavirus 2 (SARS CoV 2) and it’s associated disease COVID19 has brought up challenging times for clinicians throughout the world. It was initially the unfamiliarity with the course of COVID19 and the unusual presentations associated with it that made it difficult to predict the presentation and outcome of COVID19.linicians throughout the world have been working tirelessly to fight this pandemic on the frontline and new repurpose drugs like remdesivir are offering hope of better outcome in covid with pregnancy. There have been unique presentations of COVID19 in pregnancy including a overlap with HELLP Syndrome. We report a rare case of Metabolic Acidosis as the presenting feature in COVID19 infected female who was non diabetic

CASE REPORT

DISCUSSION

CONCLUSION