St Mary's Hospital, Obstetrics Department, Imperial College NHS Trust, Praed Street, London, W1 2NY, UK.
March of Dimes Prematurity Research Centre, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, W12 0HS, UK.
BMC Pregnancy Childbirth. 2021 Jun 16;21(1):427. doi: 10.1186/s12884-021-03928-w.
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. 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.
We 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.
We discuss possible physiology and propose a management strategy for euglycaemic ketoacidosis in pregnancy.
血糖正常的酮症酸中毒（EKA）是一种不常见但很严重的病症，通常发生在有或没有糖尿病的个体经历饥饿、严重呕吐或疾病之后。酮症酸中毒与母婴发病率和死亡率相关，因此需要及时诊断和治疗。胰岛素抵抗的生理性增加使妊娠成为一种糖尿病状态，增加了对酮症的易感性。COVID-19 与糖尿病患者的更差临床结局相关，并且是血糖正常个体酮症酸中毒的独立危险因素。
我们描述了两例 SARS-CoV-2 阳性的孕妇出现血糖正常的代谢性酮症酸中毒。这两例均与母亲和胎儿的并发症有关，需要积极的液体和胰岛素复苏以及早期分娩。
我们讨论了可能的生理学，并提出了妊娠期间血糖正常的酮症酸中毒的治疗策略。
