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How Does Ketoacidosis Cause Metabolic Acidosis

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Starvation Ketoacidosis: A Cause Of Severe Anion Gap Metabolic Acidosis In Pregnancy

Abstract Pregnancy is a diabetogenic state characterized by relative insulin resistance, enhanced lipolysis, elevated free fatty acids and increased ketogenesis. In this setting, short period of starvation can precipitate ketoacidosis. This sequence of events is recognized as "accelerated starvation." Metabolic acidosis during pregnancy may have adverse impact on fetal neural development including impaired intelligence and fetal demise. Short periods of starvation during pregnancy may present as severe anion gap metabolic acidosis (AGMA). We present a 41-year-old female in her 32nd week of pregnancy, admitted with severe AGMA with pH 7.16, anion gap 31, and bicarbonate of 5 mg/dL with normal lactate levels. She was intubated and accepted to medical intensive care unit. Urine and serum acetone were positive. Evaluation for all causes of AGMA was negative. The diagnosis of starvation ketoacidosis was established in absence of other causes of AGMA. Intravenous fluids, dextrose, thiamine, and folic acid were administered with resolution of acidosis, early extubation, and subsequent normal delivery of a healthy baby at full term. Rapid reversal of acidosis and favorable outcome are achi Continue reading >>

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  1. Paraish Misra

    This side effect was very common with phenformin (metformin’s “parent drug”), and in fact led to its withdrawal from many markets. However, lactic acidosis appears to be very uncommon with metformin. In fact, whether or not lactic acidosis occurs at all with metformin is a matter of intense debate among some physicians. Nonetheless, out of safety, physicians will not prescribe metformin to patients at high risk of lactic acidosis (such as patients with advanced kidney disease).

  2. George Johnson

    This answer is not a substitute for professional medical advic...

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