Table of Contents Author Guidelines Submit a Manuscript
Case Reports in Obstetrics and Gynecology
Volume 2013, Article ID 847942, 3 pages
http://dx.doi.org/10.1155/2013/847942
Case Report

Extreme Maternal Metabolic Acidosis Leading to Fetal Distress and Emergency Caesarean Section

1Department of Intensive Care, Université Catholique de Louvain, Cliniques St-Luc, Avenue Hippocrate 10, 1200 Brussels, Belgium
2Department of Obstetrics, Université Catholique de Louvain, Cliniques St-Luc, 1200 Brussels, Belgium
3Department of Biochemistry, Université Catholique de Louvain, Cliniques St-Luc, 1200 Brussels, Belgium
4Neuromuscular Reference Centre, Université Catholique de Louvain, Cliniques St-Luc, 1200 Brussels, Belgium
5Department of Neonatology, Université Catholique de Louvain, Cliniques St-Luc, 1200 Brussels, Belgium

Received 26 April 2013; Accepted 30 May 2013

Academic Editors: A. Awonuga, S. Z. A. Badawy, X. Deffieux, C. S. Hsu, and I. M. Usta

Copyright © 2013 Nicolas Cecere et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

A 31-year-old pregnant woman ( weeks) was admitted with extreme tachypnea. She had a previous history of congenital muscular dystrophy (Ullrich’s disease) and isolated glucosuria. The patient had reduced food intake during the last 24 hours prior to admission and vomited twice. Serum glucose level was normal (112 mg/dL), while urinalysis revealed glucosuria 4+ and ketonuria 4+. ABG revealed pH 7.06, PCO2 9 mm Hg, and bicarbonate 2 mmol/L. Anion gap was 28 mmol/L. Tachypnea was a compensatory mechanism for a severe nonlactic metabolic acidosis. The diagnosis of starvation ketoacidosis was established. The patient received supplemental dextrose 10% intravenously and sodium bicarbonate. As fetal heart monitoring was pathological, an emergency caesarean section was performed. Umbilical cord venous pH was 7.01, with PCO2 34 mm Hg and bicarbonate 8 mmol/L. Starvation ketoacidosis is a rare metabolic disorder that may occur mainly in the third trimester of pregnancy. Muscular dystrophy and renal glucosuria were precipitating factors.