In the last 18 months we have seen 3 cases of severe ketoacidosis (HCO3
<5mmol/l) presenting acutely at term. The cases involve 2 patients who are
maternal cousins, one of them presenting on 2 occasions. The presentations
were essentially identical: an uneventful pregnancy with an emergency
admission due to collapse very near term. The patients had low plasma
glucoses of 2.5-3.5mmol/l, with severe ketoacidosis, normal renal and
hepatic function. On 2 occasions the foetus died very shortly after
admission: on the most recent occasion, a normal baby was delivered by C-
section immediately upon admission. Plasma and urine samples from the
patients,and from the surviving baby have been referred for metabolic
studies, showing only keto acids in the urine of the patients. On each
occasion, the ketoacidosis resolved quickly after delivery.
Has anyone seen this pattern before, and does anyone have an explanation
for it? We would be very grateful for any comments.
John Thompson
Grimsby
UK
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