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病例报告:哺乳期酮症酸中毒可使生酮饮食复杂化。

Case Report: Lactation Ketoacidosis Can Complicate the Ketogenic Diet.

机构信息

The Permanente Medical Group Inc, Sacramento, CA.

出版信息

Perm J. 2021 Jan;25:1. doi: 10.7812/TPP/20.162.

Abstract

INTRODUCTION

Ketoacidosis is a metabolic condition caused by the buildup of ketone bodies. The most common causes are diabetes, alcoholism, and starvation. This is a case of a lactating mother on a ketogenic diet who developed a community-acquired pneumonia and then went into life-threatening ketoacidosis.

CASE PRESENTATION

A 32-year-old, lactating, 8-week-postpartum woman presented to the hospital complaining of nausea, vomiting, rhinorrhea, and cough. She had no history of diabetes or of alcohol or drug use but reported following a ketogenic diet and was found to have a pneumonia. The pneumonia was treated with antibiotics, and the acidosis resolved with a dextrose solution.

CONCLUSION

We report the case of a mother who, while lactating and losing weight on a ketogenic diet, developed a pneumonia and then went into ketoacidosis. Physicians should be aware that patients on the ketogenic diet are at risk for life-threatening acidosis, especially if they develop a second and/or third stressor or energy requirement on top of the low-carbohydrate diet. This case and those reviewed in the literature indicate that ketogenic diets may not be safe during lactation and could be associated with increased morbidity.

摘要

简介

酮症酸中毒是由酮体堆积引起的代谢紊乱。最常见的原因是糖尿病、酗酒和饥饿。这是一位哺乳期母亲的病例,她采用生酮饮食,患上社区获得性肺炎,随后发生危及生命的酮症酸中毒。

病例介绍

一位 32 岁、哺乳期、产后 8 周的女性因恶心、呕吐、流涕和咳嗽到医院就诊。她没有糖尿病史,也没有饮酒或吸毒史,但报告称正在进行生酮饮食,并被发现患有肺炎。肺炎用抗生素治疗,酸中毒通过葡萄糖溶液得到纠正。

结论

我们报告了一位母亲的病例,她在哺乳期进行生酮饮食以减轻体重,随后患上肺炎,继而发生酮症酸中毒。医生应意识到,进行生酮饮食的患者有发生危及生命的酸中毒的风险,尤其是在他们除了低碳水化合物饮食之外,还面临第二个和/或第三个应激源或能量需求时。本病例以及文献中回顾的病例表明,生酮饮食在哺乳期可能不安全,并可能与更高的发病率相关。

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本文引用的文献

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Ketoacidosis - Where Do the Protons Come From?酮症酸中毒——质子从何而来?
Trends Biochem Sci. 2019 Jun;44(6):484-489. doi: 10.1016/j.tibs.2019.01.005. Epub 2019 Feb 8.
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Another "D" in MUDPILES? A Review of Diet-Associated Nondiabetic Ketoacidosis.MUDPILES中的另一个“D”?与饮食相关的非糖尿病性酮症酸中毒综述。
J Investig Med High Impact Case Rep. 2018 Aug 23;6:2324709618796261. doi: 10.1177/2324709618796261. eCollection 2018 Jan-Dec.
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A Ketone Ester Drink Lowers Human Ghrelin and Appetite.酮酯饮料降低人体胃饥饿素和食欲。
Obesity (Silver Spring). 2018 Feb;26(2):269-273. doi: 10.1002/oby.22051. Epub 2017 Nov 6.
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