Maastricht University Medical Centre, Internal Medicine, Postbus 5800, 6202 AZ Maastricht, The Netherlands.
J Clin Endocrinol Metab. 2012 Sep;97(9):3021-4. doi: 10.1210/jc.2012-1391. Epub 2012 Jul 12.
We report on a case of nondiabetic ketoacidosis due to mild starvation in a third term twin pregnancy.
The aim was to present a case report and review of the literature in nondiabetic ketoacidosis in pregnancy, including precipitating factors and underlying pathophysiology.
The case report includes collation of earlier data and literature review.
The patient was admitted to the obstetrics ward of a large general hospital and, after cesarean section, was transferred to the intensive care unit.
We present the case of a 26-yr-old obese patient with a 35-wk twin pregnancy.
We provided appropriate management with fluid infusion after cesarean delivery.
The patient and her two daughters survived, and no disabilities were foreseen. Alcohol, methanol, and lactic acid levels were normal. No signs of renal disease or diabetes were present. Pathological examination revealed no abnormalities of the placentae. Toxicological tests revealed a salicylate level of less than 5 mg/liter, an acetaminophen level of less than 1 mg/liter, and an acetone level of 300 mg/liter (reference, 5-20 mg/liter).
We present a case of third term twin pregnancy with high anion gap metabolic acidosis due to (mild) starvation. Starvation, obesity, third term twin pregnancy, and perhaps a gastroenteritis were the ultimate provoking factors. In the light of the erroneous suspicion of sepsis and initial fluid therapy lacking glucose, one wonders whether, under a different fluid regime, cesarean section could have been avoided. Severe ketoacidosis in the pregnant woman is associated with impaired neurodevelopment. It therefore demands early recognition and immediate intervention.
我们报告了一例由于第三孕期双胞胎妊娠的轻度饥饿引起的非糖尿病酮症酸中毒。
旨在报告一例非糖尿病酮症酸中毒病例，并对妊娠期间非糖尿病酮症酸中毒的诱发因素和潜在病理生理学进行文献复习。
病例报告包括早期数据的整理和文献复习。
患者被收治于一家大型综合医院的产科病房，行剖宫产术后转至重症监护病房。
我们报告了一例 26 岁肥胖的 35 周双胞胎妊娠患者。
我们在剖宫产术后提供了适当的液体输注管理。
患者和她的两个女儿均存活，且无预期残疾。酒精、甲醇和乳酸水平正常。无肾脏疾病或糖尿病的迹象。病理检查未发现胎盘异常。毒理学检测显示血水杨酸盐水平<5mg/L，对乙酰氨基酚水平<1mg/L，丙酮水平 300mg/L（参考值为 5-20mg/L）。
我们报告了一例由于（轻度）饥饿引起的第三孕期双胞胎妊娠、阴离子间隙高代谢性酸中毒病例。饥饿、肥胖、第三孕期双胞胎妊娠，或许还有胃肠炎是最终的诱发因素。鉴于对脓毒症的错误怀疑和初始不含葡萄糖的液体治疗，人们不禁会想，如果采用不同的液体方案，是否可以避免剖宫产。孕妇严重的酮症酸中毒与神经发育受损有关。因此，需要及早识别并立即干预。
