A case series of euglycemic starvation ketoacidosis in pregnant women with COVID-19 infection: atypical presentations
Authors: Nida' Ul-Huda Adznan, Carolina Shalini Singarayar, Foo Siew Hui
Background: We present a case series of euglycemic starvation ketoacidosis in pregnant women with coronavirus disease 2019 (COVID-19) infection. Our patients presented with fever and typical respiratory symptoms secondary to COVID-19 infection in the third trimester. It was complicated by severe metabolic ketoacidosis, likely contributed by the hypermetabolic state of pregnancy, maternal starvation, and increased metabolic demand due to COVID-19 infection. Case Presentation: Among most of the cases, there was a swift resolution of ketoacidosis, through timely fluid resuscitation, dextrose, and insulin. But despite those measures, most of the patients had to undergo emergency cesarean section due to maternal deterioration, preterm delivery, and fetal distress. All the mothers recovered well and were discharged home, but there was one case of neonatal death after preterm delivery. Conclusion: These cases illustrate the importance of early diagnosis of euglycemic ketoacidosis, prompt management, and close monitoring to obviate adverse materno-fetal outcomes in pregnant women with COVID-19 infection.
Keywords: Euglycemic ketoacidosis, starvation ketoacidosis, pregnant, COVID-19, metabolic acidosis, high anion gap, case report.
Authors
Carolina Shalini Singarayar
Consultant Endocrinologist, Endocrine Unit, Medical Department, Selayang Hospital, Ministry of Health, Batu Caves, Malaysia
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Correspondence to:
Nida' Ul-Huda Adznan, Acute Internal Medicine Physician, Medical Department, Selayang Hospital, Ministry of Health, Malaysia huda.adznan@gmail.com
Publication history:
Received 07 Dec 2022
Revised 01 Apr 2023
Accepted 22 May 2023
Published online 01 Aug 2023
Published in print 09 Aug 2023
Adznan NU, Singarayar CS, Hui FS. A case series of euglycemic starvation ketoacidosis in pregnant women with COVID-19 infection: atypical presentations. EJMCR. 2023; 7(5): 110-114. doi:
10.24911/ejmcr/173-1670397398
Adznan NU, Singarayar CS, Hui FS. A case series of euglycemic starvation ketoacidosis in pregnant women with COVID-19 infection: atypical presentations. https://www.ejmcr.com/?mno=92043 [Access: September 22, 2023]. doi:
10.24911/ejmcr/173-1670397398
Adznan NU, Singarayar CS, Hui FS. A case series of euglycemic starvation ketoacidosis in pregnant women with COVID-19 infection: atypical presentations. EJMCR. 2023; 7(5): 110-114. doi:
10.24911/ejmcr/173-1670397398
Adznan NU, Singarayar CS, Hui FS. A case series of euglycemic starvation ketoacidosis in pregnant women with COVID-19 infection: atypical presentations. EJMCR. (2023), [cited September 22, 2023]; 7(5): 110-114. doi:
10.24911/ejmcr/173-1670397398
Adznan, N. U., Singarayar, . C. S. & Hui, . F. S. (2023) A case series of euglycemic starvation ketoacidosis in pregnant women with COVID-19 infection: atypical presentations. EJMCR, 7 (5), 110-114. doi:
10.24911/ejmcr/173-1670397398
Adznan, Nida Ul-Huda, Carolina Shalini Singarayar, and Foo Siew Hui. 2023. A case series of euglycemic starvation ketoacidosis in pregnant women with COVID-19 infection: atypical presentations. European Journal of Medical Case Reports, 7 (5), 110-114. doi:
10.24911/ejmcr/173-1670397398
Adznan, Nida Ul-Huda, Carolina Shalini Singarayar, and Foo Siew Hui. "A case series of euglycemic starvation ketoacidosis in pregnant women with COVID-19 infection: atypical presentations." European Journal of Medical Case Reports 7 (2023), 110-114. doi:
10.24911/ejmcr/173-1670397398
Adznan, Nida Ul-Huda, Carolina Shalini Singarayar, and Foo Siew Hui. "A case series of euglycemic starvation ketoacidosis in pregnant women with COVID-19 infection: atypical presentations." European Journal of Medical Case Reports 7.5 (2023), 110-114. Print. doi:
10.24911/ejmcr/173-1670397398
Adznan, N. U., Singarayar, . C. S. & Hui, . F. S. (2023) A case series of euglycemic starvation ketoacidosis in pregnant women with COVID-19 infection: atypical presentations. European Journal of Medical Case Reports, 7 (5), 110-114. doi:
10.24911/ejmcr/173-1670397398