Treatment of Starvation Ketoacidosis in the Third Trimester of Pregnancy: A Case Report

Authors

Christine Le, HCA HealthcareFollow
Charmaine Oladell
Nicole Tenzel, HCA HealthcareFollow

Files

Division

North Texas

Hospital

Medical City Arlington

Specialty

Obstetrics & Gynecology

Document Type

Poster

Publication Date

2025

Keywords

ketoacidosis, starvation ketoacidosis, pregnancy complications

Disciplines

Female Urogenital Diseases and Pregnancy Complications | Medicine and Health Sciences | Obstetrics and Gynecology

Abstract

INTRODUCTION: Starvation ketoacidosis represents a rare but complicated maternal morbidity that primarily occurs in the third trimester of pregnancy. With increased insulin resistance and metabolism manifesting in pregnancy, prompt care is required to diagnose and treat starvation ketoacidosis as it appears at an accelerated rate. However, despite the severity of maternal and fetal complications arising from this condition, standardized treatment protocols have not been elucidated. CASE PRESENTATION: In this case report, a 33-year-old gravida 3 para 0-2-0-2 at 31 weeks and 5 days gestational age was admitted to antepartum services for intractable nausea, vomiting, and anuria and transferred to the intensive care unit (ICU) on hospital day 3 for starvation ketoacidosis. Prior to ICU transfer, the patient was started on intravenous (IV) Lactated Ringer’s (LR) solution that was transitioned to IV LR with dextrose 5% solution. Laboratory values indicated metabolic acidosis with pH 7.221, partial pressure of CO2 (PaCO2) of 12.9 mmHg, partial pressure of oxygen (PaO2) 91.2 mmHg, and bicarbonate 5.3 mmol/L on arterial blood gas. Serum bicarbonate <10 mmol/L on comprehensive metabolic panel. In the ICU, IV fluids were converted to IV 5% Dextrose with 8.4% sodium bicarbonate. Anti-emetic regimen of IV Metoclopramide, IV Ondansetron, rectal Promethazine, and IV Famotidine were continued. Despite 12 hours of treatment, serum bicarbonate and clinic status did not change. Two pushes of IV sodium bicarbonate 8.4% 50 mL solution and Clinimix electrolyte solution was initiated. After 19 hours of continuous IV 5% Dextrose with 8.4% sodium bicarbonate containing fluids, serum bicarbonate improved to 18 mmol/L. The patient was transitioned to a clear liquid diet and didn’t require enteral or parenteral nutrition. However, due to category 3 fetal heart tracing and biophysical profile score of 4/10 despite improved maternal clinical status, an emergent cesarean section was performed on hospital day 4. LEARNING POINTS: In this case, successful treatment of starvation ketoacidosis was achieved with dextrose and sodium bicarbonate IV fluids without enteral or parental nutrition in less than 24 hours. Although the pregnancy concluded with an emergent cesarean section, we can extrapolate a potential regimen to treat starvation ketoacidosis. Our protocol underscores the need for early diagnosis with aggressive treatment and highlights prompt adjustment of treatment regimens when clinical status and laboratory values fail to improve. This case will further expand on the scarce case reports of starvation ketoacidosis in pregnancy and shed light on possible standardized treatment regimens for similar patient presentations.

Original Publisher

HCA Healthcare Graduate Medical Education

Recommended Citation

Le, Christine; Oladell, Charmaine; and Tenzel, Nicole, "Treatment of Starvation Ketoacidosis in the Third Trimester of Pregnancy: A Case Report" (2025). North Texas Research Forum 2025. 95.
https://scholarlycommons.hcahealthcare.com/northtexas2025/95