Starvation Ketoacidosis in Pregnancy: An Unusual Presentation and Brief Literature Review.

Starvation ketoacidosis in pregnant patients is a rare but life-threatening condition that requires prompt diagnosis and timely treatment. A 35-year-old pregnant woman at 33 weeks' gestation was admitted for abdominal pain with poor oral intake. She was diagnosed with perforated appendicitis and underwent emergent laparotomy. During the procedure and afterwards, she was found to have an anion gap metabolic acidosis. She was treated with a dextrose infusion with a fixed-rate insulin with correction of metabolic parameters. Women in late pregnancy are at increased risk for ketosis from increased relative insulin resistance and enhanced lipolysis. There is no consensus on optimal management of starvation ketoacidosis of pregnancy; however, carbohydrate administration is a cornerstone of treatment. We chose simultaneous administration of carbohydrates with insulin to overcome any inherent insulin resistance and to suppress lipolysis with rapid resolution of the patient's metabolic derangements.