Starvation ketoacidosis in pregnancy (1130)
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Any cause of metabolic acidosis in pregnancy should be promptly recognised and managed in order to prevent fetal acidemia, hypoxia and intrauterine death. Severe metabolic acidosis in pregnancy is usually secondary to diabetic ketoacidosis, sepsis or rare metabolic conditions, but can be caused by starvation or poor nutrition.
Metabolic changes in pregnancy include increased insulin resistance, increased lipolysis and elevated level of free fatty acids which are driven by factors such as increased oestrogen and human placental lactogen. As a result, pregnant women are more susceptible to ketosis than non-pregnant patients and a relatively short period of starvation may precipitate ketoacidosis, particularly in the 2nd and 3rd trimesters when there is increasing insulin resistance with gestation.