Conclusions

Maternal acidosis is a medical emergency, in which both mother and child are at risk for significant morbidity and mortality. Acute starvation in the third trimester of pregnancy may give maternal metabolic ketoacidosis. Patients with comorbidity such as gestational diabetes and preeclampsia may be more at risk to develop starvation ketoacidosis. Due to the higher tendency of ketogenesis in pregnancy, clinicians should be aware of the risks of starvation. Urinalysis should be performed when a patients has symptoms of dyspnoea, nausea and vomiting. A respiratory rate above 16 breaths per minute is one of the warning symptoms for respiratory distress and is associated with an increased risk for ICU admission. When ketones are found in urinalysis and the patient is in respiratory distress, arterial blood gas is advised. When starvation has occurred, substituting nutrients, intravenous glucose and prevention of circulatory hypovolemia are recommended. Potassium should be added to prevent hypokalaemia when acidosis subsides. Daily monitoring of respiratory rate, urine analysis for ketones and electrolytes are recommended to monitor a safe transition to a normal metabolic balance. To prevent maternal and fetal morbidity, the problem of acute starvation should be identified rapidly and the right treatment with substitution should be given on time.