Subject(s)
COVID-19/epidemiology , Pre-Eclampsia/epidemiology , Pregnancy Complications/epidemiology , Pregnancy , Premature Birth/epidemiology , COVID-19/complications , Causality , Female , Humans , Patient Acuity , Pre-Eclampsia/virology , Premature Birth/virology , Retrospective Studies , Risk , SARS-CoV-2 , State Medicine , United Kingdom/epidemiologyABSTRACT
BACKGROUND: Euglycaemic ketoacidosis (EKA) is an infrequent but serious condition which usually follows a period of starvation, severe vomiting or illness in individuals with or without diabetes. Ketoacidosis is associated with materno-fetal morbidity and mortality necessitating prompt diagnosis and management. Physiological increases in insulin resistance render pregnancy a diabetogenic state with increased susceptibility to ketosis. COVID-19 is associated with worse clinical outcomes in patients with diabetes and is an independent risk factor for ketoacidosis in normoglycaemic individuals. CASE PRESENTATIONS: We describe two cases of SARS-CoV-2 positive pregnant women presenting with normoglycaemic metabolic ketoacidosis. Both cases were associated with maternal and fetal compromise, requiring aggressive fluid and insulin resuscitation and early delivery. CONCLUSION: We discuss possible physiology and propose a management strategy for euglycaemic ketoacidosis in pregnancy.