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.