Cetoacidosis normoglicémica en paciente embarazada con neumonía por COVID-19. Reporte de un caso clínico / Euglycaemic ketoacidosis in a pregnant woman with COVID-19 pneumonia. A case report

RESUMEN Introducción: La cetoacidosis en el embarazo es una emergencia médica que requiere tratamiento en Unidad de Cuidados Intensivos debido a su asociación con morbimortalidad maternofetal. Las gestantes pueden presentar una forma atípica del cuadro llamada cetoacidosis normoglicémica, siendo muy infrecuente en pacientes sin antecedente de diabetes. Caso Clínico: Se presenta una gestante cursando tercer trimestre de embarazo, sin antecedente de diabetes, ingresada en Unidad de Paciente Crítico debido a neumonía por COVID-19 y acidosis metabólica con anión gap aumentado. Se realizó diagnóstico de cetoacidosis normoglicémica posterior al ingreso, iniciándose tratamiento intensivo de trastorno ácido-base con buena evolución. Conclusión: La infección por SARS-CoV-2 puede causar cetoacidosis normoglicémicas en embarazadas no diabéticas; se requiere una alta sospecha clínica para realizar el diagnóstico y tratamiento oportuno.

ABSTRACT Introduction: Ketoacidosis in pregnancy is a medical emergency that requires treatment in an intensive care unit due to its association with maternal-fetal morbimortality. Pregnant women may present an atypical form of the condition called normoglycemic ketoacidosis, being very rare in patients with no history of diabetes. Clinical Case: We present a pregnant woman in the third trimester of pregnancy, without history of diabetes, admitted to a critical patient unit due to COVID-19 pneumonia and metabolic acidosis with an increased anion gap. A diagnosis of normoglycemic ketoacidosis was made after admission, and intensive treatment of acid-base disorder was initiated, with good evolution. Conclusion: SARS-CoV-2 infection can cause normoglycemic ketoacidosis in non-diabetic pregnant women; is required a high clinical suspicion to make the diagnosis and appropriate treatment.

Efeito alcalinizante da solução de Ringer com lactato em ovelhas sadias e acidóticas / Alkalinizing effect of lactated Ringer's solution in healthy and acidotic sheep

O estudo teve o objetivo de testar a hipótese de que o efeito alcalinizante da solução de Ringer com lactato (SRL) pode ser maior nos animais portadores de acidose metabólica do que nos sadios, como consequência da necessidade de retorno ao equilíbrio. Seis ovelhas receberam a SRL em volume correspondente a 10% do peso corporal, administrada por infusão contínua intravenosa, durante quatro horas, em duas condições definidas: enquanto eram saudáveis e após a indução experimental de acidose láctica ruminal aguda (ALRA). Amostras de sangue venoso e de urina foram colhidas em quatro momentos: antes do início da infusão, na metade do volume infundido, ao término da infusão e duas horas após. Foram determinados valores de pH sanguíneo e urinário, de pCO2, HCO3 - e BE no sangue, de Na+, K+, Cl-, SID, AG, PPT, Atot e lactato L no plasma, e das excreções fracionadas urinárias de Na+, K+, Cl- e lactato L. A SRL provocou hemodiluição, mas não interferiu nos equilíbrios eletrolítico e acidobase das ovelhas sadias. Apesar de eficaz para reverter a desidratação, não foi capaz de corrigir a acidose metabólica presente após a indução da ALRA.

The aim of this study was to investigate if the alkalinizing effect of lactated Ringer's solution (LRS) is greater in animals with metabolic acidosis than in healthy ones, as a result of the need to restore acid-base balance. LRS was intravenously infused in a volume corresponding to 10% of body weight, continously during four hours, in two definite conditions in the same six ewes: when they were healthy and after experimentally induced acute rumen lactic acidosis (ARLA). Venous blood and urine samples were taken in four moments: before the beginning, in the middle, at the end of the infusion and two hours after. Blood and urine pH, blood pCO2, HCO3 - and BE, and plasma Na+, K+, Cl-, TP and L lactate were measured. Na+, K+, Cl- and L lactate fractional clearance and plasma SID, AG, and Atot were calculated. LRS caused hemodilution but didn't change electrolyte and acid-base balances in healthy ewes. When ewes were affected by ARLA, the infusion of this solution was effective for dehydration reversion but was unable to correct metabolic acidosis.