Abraham Lisa, Ning Xinyuan, Whitlatch Hilary B
Department of General Internal Medicine, University of Maryland Medical Center, Baltimore, MD 21201, USA.
Division of Endocrinology, Diabetes, and Nutrition, University of Maryland Medical Center, Baltimore, MD 21201, USA.
JCEM Case Rep. 2024 Aug 16;2(9):luae145. doi: 10.1210/jcemcr/luae145. eCollection 2024 Sep.
Starvation ketoacidosis in pregnant patients is a rare but life-threatening condition that requires prompt diagnosis and timely treatment. A 35-year-old pregnant woman at 33 weeks' gestation was admitted for abdominal pain with poor oral intake. She was diagnosed with perforated appendicitis and underwent emergent laparotomy. During the procedure and afterwards, she was found to have an anion gap metabolic acidosis. She was treated with a dextrose infusion with a fixed-rate insulin with correction of metabolic parameters. Women in late pregnancy are at increased risk for ketosis from increased relative insulin resistance and enhanced lipolysis. There is no consensus on optimal management of starvation ketoacidosis of pregnancy; however, carbohydrate administration is a cornerstone of treatment. We chose simultaneous administration of carbohydrates with insulin to overcome any inherent insulin resistance and to suppress lipolysis with rapid resolution of the patient's metabolic derangements.
妊娠患者的饥饿性酮症酸中毒是一种罕见但危及生命的疾病，需要及时诊断和治疗。一名35岁、孕33周的孕妇因腹痛、口服摄入不足入院。她被诊断为阑尾穿孔并接受了急诊剖腹手术。术中及术后，发现她存在阴离子间隙代谢性酸中毒。给予她葡萄糖输注并固定速率注射胰岛素，以纠正代谢参数。妊娠晚期女性因相对胰岛素抵抗增加和脂肪分解增强，发生酮症的风险增加。对于妊娠饥饿性酮症酸中毒的最佳管理尚无共识；然而，碳水化合物给药是治疗的基石。我们选择同时给予碳水化合物和胰岛素，以克服任何固有的胰岛素抵抗，并通过迅速纠正患者的代谢紊乱来抑制脂肪分解。
