Ketoacidosis associated with low-carbohydrate diet in a non-diabetic lactating woman: a case report

Journal of Medical Case Reports

Magnus Ekelund¹  Louise von Geijer² 

[1] Department of Internal Medicine, Helsingborg Hospital, Helsingborg, SE-251 87, Sweden;Department of Gynaecology & Obstetrics, Helsingborg Hospital, Helsingborg, SE-251 87, Sweden

关键词: Low-carbohydrate;    LCHF diet;    Lactation;    Ketoacidosis;    Diet;   

Others  :  1233284
DOI  :  10.1186/s13256-015-0709-2

 received in 2015-02-11, accepted in 2015-09-15,  发布年份 2015

【 摘 要 】

Introduction

Non-diabetic ketoacidosis is a rare condition which can be caused by starvation. Lack of glucose can force the body into ketogenesis causing a metabolic acidosis. As previously reported in the literature, ketoacidosis might, on rare occasions, be caused by a diet with low carbohydrate content. However, to the best of our knowledge this is the first reported case in the literature of ketoacidosis, in a non-diabetic patient, associated with a combination of low carbohydrate, high fat diet and lactation.

Case presentation

A healthy non-diabetic, 32-year old white woman started a low carbohydrate, high fat diet when she was breastfeeding her son of 10 months of age. After 10 days she was admitted to our hospital with nausea and vomiting and a serum pH of 7.20 and base excess of −19. Clinical signs and blood samples were compatible with ketoacidosis. She was given fluids intravenously and insulin. No anamnestic or clinical signs of diabetes were found. She recovered quickly and was discharged 3 days later.

Conclusions

Ketogenic diets like low carbohydrate, high fat may induce ketoacidosis. Lactation might further aggravate the condition and can perhaps even be the trigger into ketoacidosis. Health services should be aware of the risks associated with ketogenic diets, and be able to recognize this serious condition when it is presented.

【 授权许可】

   
2015 von Geijer and Ekelund.

【 参考文献 】

• [1]Holtenius P, Holtenius K. New aspects of ketone bodies in energy metabolism of dairy cows: a review. J Vet Med. 1996; 43:579-87.
• [2]Standing committee on the scientific evaluation of dietary reference intakes. National Academy Press, Washington DC; 2005.
• [3]Shah P, Isley WL. Ketoacidosis during a low-carbohydrate diet. N Engl J Med. 2006; 354:1.
• [4]Chen TY, Smith W, Rosenstock JL. A life-threatening complication of Atkins diet. Lancet. 2006; 367:958.
• [5]Ferrier DR. Biochemistry. hth ed. Lippincott’s Illustrated Reviews, Baltimore; 2013.
• [6]Stillman IM. The doctor’s quick weight loss diet. Dell publishing, New York; 1967.
• [7]Atkins RC. Dr. Atkins diet revolution: the high calorie way to stay thin forever. David McKay, New York; 1972.
• [8]SBU rapport 2010. Mat vid Diabetes, Sweden; 2010.
• [9]Szulewski A, Howes D, Ross Morton A. A severe case of iatrogenic lactation ketoacidosis. BMJ Case Reports. 2012. doi:10.1136/bcr.12.2011.5409.
• [10]Chernow B, Finton C, Rainey TG, O’Brian J. ‘Bovine ketosis’ in a nondiabetic postpartum woman. Diabetes Care. 1982; 5(1):47-9.
• [11]Sandhu HS, Michelis MF, DeVita MV. A case of bovine ketoacidosis in a lactating woman. NDT Plus. 2009; 2:278-9.
• [12]Heffner AC, Johnson DP. A case of lactation “bovine” ketoacidosis. J Emerg Med. 2008; 35:38.
• [13]Altus P, Hickman JW. Severe spontaneous ‘bovine’ ketoacidosis in a lactating woman. J Indiana State Med Assoc. 1983; 76:392-3.
• [14]Monnier D, Goulenok T, Allary J, Zarrouk V, Fantin B. Starvation ketosis in a breastfeeding woman. Rev Med Interne. 2015; Epub Apr 22.