• A & A case reports · Aug 2016

    Case Reports

    Life-Threatening Lactation or "Bovine" Ketoacidosis: A Case Report.

    • David J Greaney and Pat Benson.
    • From the Department of Anaesthesia and Critical Care, St. Vincent's University Hospital, Dublin, Ireland.
    • A A Case Rep. 2016 Aug 15; 7 (4): 81-4.

    AbstractLactation or "bovine" ketoacidosis is a rare cause of raised anion gap metabolic acidosis whereby a perfect storm of negative calorie balance (starvation/glucose preferentially used for milk production) and insulin resistance (counter regulatory stress hormone release/infection) leads to a dysregulated ketogenic state. We present a case of life-threatening lactation-related ketoacidosis in a patient 9 weeks postpartum, who presented to the emergency department with an arterial pH of 6.88, HCO3 of 5.8 mmol/L and blood ketone level of 5.8 mmol/L. Treatment consists of aggressive glucose loading, triggering supraphysiologic endogenous insulin release, and subsequent inhibition of ketone body formation.

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