tetano
Editor, Senior Moderator
Ann Med
. 2025 Dec;57(1):2445189.
doi: 10.1080/07853890.2024.2445189. Epub 2024 Dec 23. Metabolic acidosis with elevated anion gap and euglycemic ketoacidosis in pregnant and postpartum women with severe Covid-19
Isabel Cristina Melo Mendes[SUP] 1 2 [/SUP], Ana Luiza Martins de Oliveira[SUP] 2 [/SUP], Priscila Martins Pinheiro Trindade[SUP] 3 [/SUP], Wallace Mendes da Silva[SUP] 4 [/SUP], Clarisse Pimentel[SUP] 2 [/SUP], Raissa de Moraes Perlingeiro[SUP] 2 [/SUP], Cristiane Melo Guedes[SUP] 5 [/SUP], Claudia Caminha Escosteguy[SUP] 6 [/SUP], Rafael Mello Galliez[SUP] 2 7 8 [/SUP]
Affiliations
Background/objectives: Pregnant and postpartum women have a higher risk for developing severe Covid-19 and other clinical and obstetric complications. This study aims to evaluate the frequency of metabolic acidosis with elevated anion gap and describe a case series of euglycemic ketoacidosis (EKA) in pregnant and postpartum women with severe confirmed or suspected Covid-19.
Materials and methods: Observational retrospective study carried in a reference intensive care unit from May 2020 to June 2022. Cases were confirmed with positive RT-PCR or rapid antigen test. Cases with compatible clinical and radiologic findings were also included. Ketoacidosis was defined as the presence of metabolic acidosis with high anion gap (bicarbonate < 15 mEq/L and AG > 10 mEq/L) and ketonuria (2+ or more in urine test). Statistical analyses were made with R software.
Results: Of 101 admissions, 61 (60.4%) presented metabolic acidosis with high anion gap. The median age was 29 years, and most were in the third trimester. Evolution to invasive mechanical ventilation (54.0%) and obstetric complications (78.0%) were frequent. The prevalence of metabolic acidosis with high anion gap and absence of hyperlactatemia was of 43.6% (44/101). Six (5.94%) women met the criteria for EKA. Despite severity, there were no deaths.
Conclusions: The prevalence of metabolic acidosis and EKA in pregnant and postpartum women with severe Covid-19 was high. This condition should be routinely, so it can be promptly treated.
Keywords: Covid-19; ketoacidosis; pregnancy; puerperium; starvation ketosis.
. 2025 Dec;57(1):2445189.
doi: 10.1080/07853890.2024.2445189. Epub 2024 Dec 23. Metabolic acidosis with elevated anion gap and euglycemic ketoacidosis in pregnant and postpartum women with severe Covid-19
Isabel Cristina Melo Mendes[SUP] 1 2 [/SUP], Ana Luiza Martins de Oliveira[SUP] 2 [/SUP], Priscila Martins Pinheiro Trindade[SUP] 3 [/SUP], Wallace Mendes da Silva[SUP] 4 [/SUP], Clarisse Pimentel[SUP] 2 [/SUP], Raissa de Moraes Perlingeiro[SUP] 2 [/SUP], Cristiane Melo Guedes[SUP] 5 [/SUP], Claudia Caminha Escosteguy[SUP] 6 [/SUP], Rafael Mello Galliez[SUP] 2 7 8 [/SUP]
Affiliations
- PMID: 39713883
- DOI: 10.1080/07853890.2024.2445189
Background/objectives: Pregnant and postpartum women have a higher risk for developing severe Covid-19 and other clinical and obstetric complications. This study aims to evaluate the frequency of metabolic acidosis with elevated anion gap and describe a case series of euglycemic ketoacidosis (EKA) in pregnant and postpartum women with severe confirmed or suspected Covid-19.
Materials and methods: Observational retrospective study carried in a reference intensive care unit from May 2020 to June 2022. Cases were confirmed with positive RT-PCR or rapid antigen test. Cases with compatible clinical and radiologic findings were also included. Ketoacidosis was defined as the presence of metabolic acidosis with high anion gap (bicarbonate < 15 mEq/L and AG > 10 mEq/L) and ketonuria (2+ or more in urine test). Statistical analyses were made with R software.
Results: Of 101 admissions, 61 (60.4%) presented metabolic acidosis with high anion gap. The median age was 29 years, and most were in the third trimester. Evolution to invasive mechanical ventilation (54.0%) and obstetric complications (78.0%) were frequent. The prevalence of metabolic acidosis with high anion gap and absence of hyperlactatemia was of 43.6% (44/101). Six (5.94%) women met the criteria for EKA. Despite severity, there were no deaths.
Conclusions: The prevalence of metabolic acidosis and EKA in pregnant and postpartum women with severe Covid-19 was high. This condition should be routinely, so it can be promptly treated.
Keywords: Covid-19; ketoacidosis; pregnancy; puerperium; starvation ketosis.