Melo Mendes Isabel Cristina, Martins de Oliveira Ana Luiza, Pinheiro Trindade Priscila Martins, Mendes da Silva Wallace, Pimentel Clarisse, Perlingeiro Raissa de Moraes, Melo Guedes Cristiane, Caminha Escosteguy Claudia, Galliez Rafael Mello
Infectious Diseases Post-graduation Program, Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil.
Intensive Care Unit, State Institute for Infectious Diseases São Sebastião, Rio de Janeiro, Rio de Janeiro, Brazil.
Ann Med. 2025 Dec;57(1):2445189. doi: 10.1080/07853890.2024.2445189. Epub 2024 Dec 23.
BACKGROUND/OBJECTIVES: Pregnant and postpartum women have a higher risk for developing severe Covid-19 and other clinical and obstetric complications. This study aims to evaluate the frequency of metabolic acidosis with elevated anion gap and describe a case series of euglycemic ketoacidosis (EKA) in pregnant and postpartum women with severe confirmed or suspected Covid-19.
Observational retrospective study carried in a reference intensive care unit from May 2020 to June 2022. Cases were confirmed with positive RT-PCR or rapid antigen test. Cases with compatible clinical and radiologic findings were also included. Ketoacidosis was defined as the presence of metabolic acidosis with high anion gap (bicarbonate < 15 mEq/L and AG > 10 mEq/L) and ketonuria (2+ or more in urine test). Statistical analyses were made with R software.
Of 101 admissions, 61 (60.4%) presented metabolic acidosis with high anion gap. The median age was 29 years, and most were in the third trimester. Evolution to invasive mechanical ventilation (54.0%) and obstetric complications (78.0%) were frequent. The prevalence of metabolic acidosis with high anion gap and absence of hyperlactatemia was of 43.6% (44/101). Six (5.94%) women met the criteria for EKA. Despite severity, there were no deaths.
The prevalence of metabolic acidosis and EKA in pregnant and postpartum women with severe Covid-19 was high. This condition should be routinely, so it can be promptly treated.
背景/目的：孕妇和产后女性患重症新型冠状病毒肺炎（Covid-19）及其他临床和产科并发症的风险更高。本研究旨在评估阴离子间隙升高的代谢性酸中毒的发生率，并描述一系列确诊或疑似重症Covid-19的孕妇和产后女性的正常血糖性酮症酸中毒（EKA）病例。
2020年5月至2022年6月在一家参考重症监护病房进行观察性回顾性研究。病例通过逆转录聚合酶链反应（RT-PCR）阳性或快速抗原检测确诊。具有相符临床和影像学表现的病例也被纳入。酮症酸中毒定义为存在高阴离子间隙的代谢性酸中毒（碳酸氢盐<15 mEq/L且阴离子间隙>10 mEq/L）和酮尿症（尿检为2+或更高）。使用R软件进行统计分析。
在101例入院患者中，61例（60.4%）出现高阴离子间隙的代谢性酸中毒。中位年龄为29岁，大多数处于孕晚期。有创机械通气（54.0%）和产科并发症（78.0%）的进展很常见。高阴离子间隙且无高乳酸血症的代谢性酸中毒患病率为43.6%（44/101）。6名（5.94%）女性符合EKA标准。尽管病情严重，但无死亡病例。
重症Covid-19的孕妇和产后女性中代谢性酸中毒和EKA的患病率很高。应常规检查，以便能及时治疗。
