Introduction

Acute starvation ketoacidosis in pregnancy is a rare affliction with a severe course of disease for both mother and child. Early recognition and immediate management are required to minimize the risk of severe outcome. Ketoacidosis occurs more often in patients with diabetes mellitus type 1 or alcoholic abuse.1-2 In rare cases, metabolic acidosis can be a consequence of acute starvation in the third trimester of pregnancy in non-diabetic patients.3-8Many cases show patients presenting themselves with a short period of fasting, accompanied by vomiting while patients look clinically disproportionally well. This kind of presentation also may cause a delay in recognition and therapy, resulting in a progression of metabolic acidosis with potentially fatal consequences. We describe a case of respiratory distress and starvation induced severe metabolic acidosis during third trimester in a pregnancy complicated by preeclampsia and gestational diabetes.