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Starvation Ketosis And Pregnancy

Of 'fasting Ketosis And Alcoholic Ketoacidosis'

Of 'fasting Ketosis And Alcoholic Ketoacidosis'

TI A case of severe starvation ketoacidosis developing during pregnancy is presented. The insulinopenic/insulin-resistant state found during fasting in late gestation predisposes to ketosis. Superimposition of stress hormones, which further augment lipolysis, exacerbates the degree of ketoacidosis. In our patient, gestational diabetes, twin pregnancies, preterm labor, and occult infection were factors that contributed to severe starvation ketoacidosis. Diagnosis was delayed because starvation ketosis is not generally considered to be a cause of severe acidosis, and because the anion gap was not elevated. Improved understanding of the complex fuel metabolism during pregnancy should aid in prevention, early recognition, and appropriate therapy of this condition. Continue reading >>

Starvation Ketoacidosis In Pregnancy

Starvation Ketoacidosis In Pregnancy

Abstract Starvation ketosis outside pregnancy is rare and infrequently causes a severe acidosis. Placental production of hormones, including glucagon and human placental lactogen, leads to the insulin resistance that is seen in pregnancy, which in turn increases susceptibility to ketosis particularly in the third trimester. Starvation ketoacidosis in pregnancy has been reported and is usually precipitated by a period of severe vomiting. Ketoacidosis is likely to have important implications for fetal survival as ketoacidosis in women with type 1 diabetes mellitus is associated with intrauterine death. This article features four cases of women with vomiting in the third trimester of pregnancy associated with a severe metabolic acidosis. The mechanism underlying ketogenesis, the evidence for accelerated ketogenesis in pregnancy and other similar published cases are reviewed. A proposed strategy for management of these women is presented. Continue reading >>

Extreme Gestational Starvation Ketoacidosis: Case Report And Review Of Pathophysiology

Extreme Gestational Starvation Ketoacidosis: Case Report And Review Of Pathophysiology

Hypocalcemia: Sensipar® lowers serum calcium and can lead to hypocalcemia. Life threatening events and fatal outcomes associated with hypocalcemia have been reported in patients treated with Sensipar®, including pediatric patients. The safety and effectiveness of Sensipar® have not been established in pediatric patients. Decreases in serum calcium can prolong the QT interval, potentially resulting in ventricular arrhythmia. Cases of QT prolongation and ventricular arrhythmia have been reported in patients treated with Sensipar®. Patients with conditions that predispose to QT interval prolongation and ventricular arrhythmia may be at increased risk for QT interval prolongation and ventricular arrhythmias if they develop hypocalcemia due to Sensipar®. Closely monitor corrected serum calcium and QT interval in patients at risk receiving Sensipar®. Concurrent administration of Sensipar® with calcium-lowering drugs including other calcimimetics could result in severe hypocalcemia. Parsabiv™ (etelcalcetide) and Sensipar® should not be given together. Closely monitor serum calcium in patients receiving Sensipar® and concomitant therapies known to lower serum calcium levels. Serum calcium and serum phosphorus should be measured within 1 week and PTH should be measured 1 to 4 weeks after initiation or dose adjustment of Sensipar®. Once the maintenance dose has been established, serum calcium and serum phosphorus should be measured approximately monthly, and PTH every 1 to 3 months. Patients with risk factors for upper GI bleeding, such as known gastritis, esophagitis, ulcers or severe vomiting, may be at increased risk for GI bleeding with Sensipar®. Monitor patients for worsening of common Sensipar® GI adverse reactions and for signs and symptoms of GI bleeding an Continue reading >>

Starvation Ketoacidosis In Pregnancy

Starvation Ketoacidosis In Pregnancy

Abstract Starvation ketosis outside pregnancy is rare and infrequently causes a severe acidosis. Placental production of hormones, including glucagon and human placental lactogen, leads to the insulin resistance that is seen in pregnancy, which in turn increases susceptibility to ketosis particularly in the third trimester. Starvation ketoacidosis in pregnancy has been reported and is usually precipitated by a period of severe vomiting. Ketoacidosis is likely to have important implications for fetal survival as ketoacidosis in women with type 1 diabetes mellitus is associated with intrauterine death. This article features four cases of women with vomiting in the third trimester of pregnancy associated with a severe metabolic acidosis. The mechanism underlying ketogenesis, the evidence for accelerated ketogenesis in pregnancy and other similar published cases are reviewed. A proposed strategy for management of these women is presented. Continue reading >>

Starvation Ketoacidosis In Pregnancy

Starvation Ketoacidosis In Pregnancy

King's Authors Abstract Starvation ketosis outside pregnancy is rare and infrequently causes a severe acidosis. Placental production of hormones, including glucagon and human placental lactogen, leads to the insulin resistance that is seen in pregnancy, which in turn increases susceptibility to ketosis particularly in the third trimester. Starvation ketoacidosis in pregnancy has been reported and is usually precipitated by a period of severe vomiting. Ketoacidosis is likely to have important implications for fetal survival as ketoacidosis in women with type 1 diabetes mellitus is associated with intrauterine death. This article features four cases of women with vomiting in the third trimester of pregnancy associated with a severe metabolic acidosis. The mechanism underlying ketogenesis, the evidence for accelerated ketogenesis in pregnancy and other similar published cases are reviewed. A proposed strategy for management of these women is presented. Continue reading >>

Guest Blog Post: Is It Safe To Go Low Carb During Pregnancy?

Guest Blog Post: Is It Safe To Go Low Carb During Pregnancy?

Today my friend and colleague, Lily Nichols, a fellow registered dietitian and certified diabetes educator, shares her insight on carbohydrate-restricted diets during pregnancy. This is a controversial topic that I believe deserves more attention and investigation, which Lily does brilliantly in the following article. Is It Safe to Go Low Carb During Pregnancy? With the wide adoption of low-carbohydrate diets, many people question if they are safe during pregnancy. While quite a few women use a lower carbohydrate diet to conceive (since they are especially useful for women struggling with infertility[1]), most medical professionals discourage women from continuing this diet during pregnancy. I find it ironic that if you tell your doctor that you plan to eat low carb during pregnancy, they’ll say it’s unsafe, but if you say you plan to eat a diet based on fresh vegetables, meat, fish, eggs, dairy, nuts, seeds, and a little fruit, they’ll encourage you to stay the course. The controversy over the safety of low carbohydrate diets in pregnancy stems primarily from misconceptions around ketosis. It’s incorrect, but widely accepted, that ketosis during pregnancy is harmful to a developing baby. When I first dove into the research, I was shocked to find that studies on healthy, non-diabetic pregnant women (eating a “regular” diet) show a marked elevation in ketones after a 12-18 hour fast, which is akin to eating dinner at 8pm and having breakfast at 8am (or skipping breakfast entirely).[2] What’s more interesting is that pregnancy actually seems to favor a state of ketosis. Compared to non-pregnant women, blood ketone concentrations are about 3-fold higher in healthy pregnant women after an overnight fast.[3] And in late pregnancy, metabolism shifts to a state o Continue reading >>

Starvation Ketoacidosis In Pregnancy.

Starvation Ketoacidosis In Pregnancy.

Abstract Starvation ketosis outside pregnancy is rare and infrequently causes a severe acidosis. Placental production of hormones, including glucagon and human placental lactogen, leads to the insulin resistance that is seen in pregnancy, which in turn increases susceptibility to ketosis particularly in the third trimester. Starvation ketoacidosis in pregnancy has been reported and is usually precipitated by a period of severe vomiting. Ketoacidosis is likely to have important implications for fetal survival as ketoacidosis in women with type 1 diabetes mellitus is associated with intrauterine death. This article features four cases of women with vomiting in the third trimester of pregnancy associated with a severe metabolic acidosis. The mechanism underlying ketogenesis, the evidence for accelerated ketogenesis in pregnancy and other similar published cases are reviewed. A proposed strategy for management of these women is presented. Continue reading >>

Life-threatening Ketoacidosis In A Pregnant Woman With Psychotic Disorder

Life-threatening Ketoacidosis In A Pregnant Woman With Psychotic Disorder

Obesity is an increasingly common problem in pregnancy. It poses a number of challenges for physicians caring for pregnant women. One of the biggest issues is that of increased insulin resistance. This is evidenced by the increasing prevalence of gestational diabetes mellitus (GDM) and the number of women requiring oral hypoglycaemic agents or insulin during pregnancy. Pregnancy is also a time at which mental health may deteriorate, and psychiatric disorders are an important cause of maternal death in the UK.1 Newer classes of antipsychotics, in particular the ‘atypical’ or second-generation antipsychotics, are increasingly being used. Olanzapine, a commonly used atypical antipsychotic, is known to be associated with significant metabolic disturbances in the non-pregnant population, in particular weight gain and type 2 diabetes mellitus.2,3 Of concern is also the reported association of olanzapine use and unheralded diabetic ketoacidosis, which has been fatal in a number of cases.4 Ketoacidosis is most commonly seen in pregnancy in the setting of diabetes mellitus, but a number of cases of ketoacidosis with euglycaemia have also been reported following short periods of starvation.5,6 Starvation ketoacidosis is associated with a more severe acidosis than is seen in non-pregnant individuals. We describe a woman who was on olanzapine from 20 weeks of gestation, and then developed ketoacidosis after a short period of reduced oral intake. However, treatment was more challenging than in other reported cases and we attribute this to very profound insulin resistance as a consequence of concurrent olanzapine use. We speculate that olanzapine in combination with the insulin resistance attributable to pregnancy contributed to the presentation in this case. A 27-year-old female Continue reading >>

What Is Ketosis?

What Is Ketosis?

"Ketosis" is a word you'll probably see when you're looking for information on diabetes or weight loss. Is it a good thing or a bad thing? That depends. Ketosis is a normal metabolic process, something your body does to keep working. When it doesn't have enough carbohydrates from food for your cells to burn for energy, it burns fat instead. As part of this process, it makes ketones. If you're healthy and eating a balanced diet, your body controls how much fat it burns, and you don't normally make or use ketones. But when you cut way back on your calories or carbs, your body will switch to ketosis for energy. It can also happen after exercising for a long time and during pregnancy. For people with uncontrolled diabetes, ketosis is a sign of not using enough insulin. Ketosis can become dangerous when ketones build up. High levels lead to dehydration and change the chemical balance of your blood. Ketosis is a popular weight loss strategy. Low-carb eating plans include the first part of the Atkins diet and the Paleo diet, which stress proteins for fueling your body. In addition to helping you burn fat, ketosis can make you feel less hungry. It also helps you maintain muscle. For healthy people who don't have diabetes and aren't pregnant, ketosis usually kicks in after 3 or 4 days of eating less than 50 grams of carbohydrates per day. That's about 3 slices of bread, a cup of low-fat fruit yogurt, or two small bananas. You can start ketosis by fasting, too. Doctors may put children who have epilepsy on a ketogenic diet, a special high-fat, very low-carb and protein plan, because it might help prevent seizures. Adults with epilepsy sometimes eat modified Atkins diets. Some research suggests that ketogenic diets might help lower your risk of heart disease. Other studies show sp Continue reading >>

Pregnancy Toxaemia And

Pregnancy Toxaemia And

Contents Industry Background Management Nutrition Animal Health Breeding Fibre Production Fibre Marketing Meat Production and Marketing Pasture and Weed Control Economic Analysis Tanning Skins ketosis in goats The diseases pregnancy toxaemia and ketosis can cause severe problems in goats. While the diseases are clinically different and occur during different stages of pregnancy and lactation, the basis of the disorder is essentially the same: a decrease in blood sugar levels and an increase in ketones. In ruminants, glucose is synthesised mainly from propionic acid (a volatile fatty acid produced in the rumen) and from amino acids. The amount of glucose that is absorbed directly depends on how much dietary carbohydrate escapes rumen fermentation and is digested in the small intestine. This form of glucose uptake varies with different feeds as well as their treatment. Ruminants can use products from rumen fermentation, such as volatile fatty acids, for most of their energy requirements. However, the nervous system, kidneys, mammary gland and foetus have a direct requirement for glucose. During periods of peak glucose requirement (late pregnancy and early lactation) problems may arise due to a glucose deficiency. The incidence of pregnancy toxaemia and ketosis varies with the two main types of goats. In dairy goats with a genetic potential for high milk production, ketosis may be a potential problem; in non-milch goats (Angora, Cashmere and meat) pregnancy toxaemia is more common. PREGNANCY TOXAEMIA Main causes The most important cause of pregnancy toxaemia is a decline in the plane of nutrition during the last six to eight weeks of pregnancy. This places the pregnant female in a difficult situation because the developing foetus imposes an unremitting drain on available m Continue reading >>

Life Threatening Starvation Ketoacidosis In Pregnancy

Life Threatening Starvation Ketoacidosis In Pregnancy

We are pleased to present the winning entry from the March 2017 OAA Cases & Controversies meeting… Harrison J, Churchill S, Stacey M, Collis R Department of Anaesthetics, University Hospital of Wales, Cardiff Introduction Acid-Base disturbances in pregnancy can have significant consequences for mother and fetus. Metabolic acidosis with a high anion gap has a number of causes, including lactic acidosis, diabetic ketoacidosis and toxic ingestion. Cases of starvation ketoacidosis in late pregnancy have been described.1,2,3 We describe a case of life threatening metabolic ketoacidosis with normal lactate and a high anion gap in a previously healthy non diabetic woman. Case Presentation A 28 year old (G2P1) lady was admitted at 35 weeks gestation with severe vomiting of uncertain aetiology. She had required admission twice during pregnancy with hyperemesis requiring IV fluids, IV antiemetics, omeprazole and ranitidine. On admission she appeared clinically well but was vomiting frequently and tolerating nothing orally. Urine dipstick revealed ++ ketones. She was managed with IV antiemetics, including hydrocortisone and crystalloids. During the next three days she remained stable despite ongoing vomiting. On day 4 her condition deteriorated over a 4-hour period; vomiting worsened, associated with tachypnea (respiratory rate rose from 18 to 32) and tachycardia (90 to 140). Saturations remained 100% in air. There were no other new symptoms and no chest or leg pain. Corticosteroids were given for fetal lung maturation. Chest examination and x-ray were unremarkable. Arterial blood gas on air showed: pH 7.15, PO2 16.7, PCO2 1.34, Cl 110, HCO3- 7.5, BE –24.5, Lactate 1.4, anion gap 22.5. Urine dipstick showed +++ ketones and blood ketones were 6.5. Fluid resuscitation with 10% d Continue reading >>

Starvation Ketoacidosis In Pregnancy

Starvation Ketoacidosis In Pregnancy

Abstract Starvation ketosis outside pregnancy is rare and infrequently causes a severe acidosis. Placental production of hormones, including glucagon and human placental lactogen, leads to the insulin resistance that is seen in pregnancy, which in turn increases susceptibility to ketosis particularly in the third trimester. Starvation ketoacidosis in pregnancy has been reported and is usually precipitated by a period of severe vomiting. Ketoacidosis is likely to have important implications for fetal survival as ketoacidosis in women with type 1 diabetes mellitus is associated with intrauterine death. This article features four cases of women with vomiting in the third trimester of pregnancy associated with a severe metabolic acidosis. The mechanism underlying ketogenesis, the evidence for accelerated ketogenesis in pregnancy and other similar published cases are reviewed. A proposed strategy for management of these women is presented. Continue reading >>

Warning! Starvation Ketosis Is Serious

Warning! Starvation Ketosis Is Serious

Beware of Starvation Ketosis Starvation ketosis is a serious condition that happens when your pregnant body is starved for nutrition, especially carbohydrates. With starvation ketosis, your tissues begin to breakdown and the byproducts of this ketabolism are called ketones, which actually aggravate nausea. To prevent starvation ketosis, try the following: Salty fluids, such as broths in chicken soup Oral electrolyte solutions (Pedialyte, available over the counter) Sports drinks Continue reading >>

A Case Of Ketoacidosis In Pregnancy

A Case Of Ketoacidosis In Pregnancy

Abstract: Background: Pregnant women are predisposed to accelerated starvation due to continuous nutrient demands by the fetus, and they have increased susceptibility to ketogenesis during periods of caloric deprivation [1, 2]. We report a case of starvation ketoacidosis in a patient with gestational diabetes on a carbohydrate-restricted diet. Clinical case: A 30 year-old woman, gravida 5, para 2, with a history of spina bifida and hydrocephalus status post ventriculoperitoneal shunt, presented at 37 weeks of gestation with dyspnea. Her pregnancy had been complicated by gestational diabetes mellitus treated with a carbohydrate-restricted diet of 30 g a day. Due to a previous pregnancy complicated by late intrauterine fetal demise, a caesarean section was planned at 37 weeks of gestation after administration of steroids to induce fetal lung maturity. On admission, the patient’s blood pressure was 116/69 mm Hg, heart rate 106 beats per minute, oral temperature 36 °C, pulse ox 97%, and respiratory rate 20 breaths per minute. Laboratory tests showed a mixed metabolic acidosis and respiratory alkalosis with pH 7.3 (7.33 - 7.43), HCO3 7.3 meq/l (20 - 27 meq/l), positive urinary ketones, and glucose of 75 mg/dl (65 – 139 mg/dl). Her glycosylated hemoglobin was 5.8% (4.0 - 6.0 %), C-peptide level 14.3 ng/ml (0.6 - 12.0 ng/ml), total insulin level 4.1 uU/ml (5 to 25 uU/ml), and lactate 1.8 mmol/l (0.5 - 2.2 mmol/l). Her dyspnea progressed, requiring intubation followed by emergent caesarean section. Afterwards, she was transferred to the surgical intensive care unit. She was treated with intravenous fluids containing dextrose and bicarbonate; she never received insulin and her blood glucose ranged from 65 to 139 mg/dl. By hospital day 3, the metabolic acidosis resolved, and Continue reading >>

Ketosis

Ketosis

Not to be confused with Ketoacidosis. Ketosis is a metabolic state in which some of the body's energy supply comes from ketone bodies in the blood, in contrast to a state of glycolysis in which blood glucose provides energy. Ketosis is a result of metabolizing fat to provide energy. Ketosis is a nutritional process characterised by serum concentrations of ketone bodies over 0.5 mM, with low and stable levels of insulin and blood glucose.[1][2] It is almost always generalized with hyperketonemia, that is, an elevated level of ketone bodies in the blood throughout the body. Ketone bodies are formed by ketogenesis when liver glycogen stores are depleted (or from metabolising medium-chain triglycerides[3]). The main ketone bodies used for energy are acetoacetate and β-hydroxybutyrate,[4] and the levels of ketone bodies are regulated mainly by insulin and glucagon.[5] Most cells in the body can use both glucose and ketone bodies for fuel, and during ketosis, free fatty acids and glucose synthesis (gluconeogenesis) fuel the remainder. Longer-term ketosis may result from fasting or staying on a low-carbohydrate diet (ketogenic diet), and deliberately induced ketosis serves as a medical intervention for various conditions, such as intractable epilepsy, and the various types of diabetes.[6] In glycolysis, higher levels of insulin promote storage of body fat and block release of fat from adipose tissues, while in ketosis, fat reserves are readily released and consumed.[5][7] For this reason, ketosis is sometimes referred to as the body's "fat burning" mode.[8] Ketosis and ketoacidosis are similar, but ketoacidosis is an acute life-threatening state requiring prompt medical intervention while ketosis can be physiological. However, there are situations (such as treatment-resistant Continue reading >>

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