Life-Threatening Lactation or "Bovine" Ketoacidosis: A Case Report.
Lactation 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.
From the Department of Anaesthesia and Critical Care, St. Vincent's University Hospital, Dublin, Ireland.
David J
DJ
Greaney
Pat
P
Benson
D000328:Adult; D001942:Breast Feeding / Q000009:adverse effects; D005260:Female; D006801:Humans; D007662:Ketosis / Q000175:diagnosis* / Q000209:etiology / Q000378:metabolism*; D007774:Lactation / Q000378:metabolism*; D015431:Weight Loss / Q000502:physiology*