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Lactation Ketoacidosis: A Systematic Review of Case Reports

Department of Medicine, Sultan Qaboos University Hospital, Muscat 123, Oman
Oman Medical Specialty Board, Muscat 123, Oman
Division of Medicine, Royal Darwin Hospital, Darwin NT 0800, Australia
Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, 171 77 Stockholm, Sweden
Department of Molecular Medicine and Surgery, Karolinska Institute, 171 77 Stockholm, Sweden
Menzies School of Health Research, Darwin NT 0800, Australia
Author to whom correspondence should be addressed.
Medicina 2020, 56(6), 299;
Received: 15 May 2020 / Revised: 11 June 2020 / Accepted: 12 June 2020 / Published: 17 June 2020
Background and Objective: Lactation ketoacidosis is a rare cause of high anion gap metabolic acidosis affecting breastfeeding mothers. We aim to review and analyze all cases of lactation ketoacidosis reported. Materials and Methods: A systematic search of PubMed/MEDLINE and Cumulative Index to Nursing and Allied Health Literature (CINAHL), identifying relevant case reports published from 1 January 1970 to 31 December 2019. We extracted the following data: the first author, country, year of publication, age of the mother, age of the child, weight/body mass index (BMI) of the mother, precipitating factors, presenting symptoms, biochemical results, treatment, breastfeeding, and time from presentation to the resolution of ketoacidosis. Results: Sixteen case reports and 1 case series reporting 18 cases of lactation ketoacidosis were found. Presenting symptoms were nausea (72%, 13/18), vomiting (67%, 12/18), malaise (56%, 10/18), abdominal pain (44%, 8/18), dyspnea (33%, 6/18), headache (22%, 4/18), and palpitation (11%, 2/18). Dieting and physical exercise to lose weight were reported in 76% (14/18). The treatments included IV dextrose, sodium bicarbonate, insulin, rehydration, monitoring and replacement of electrolytes, and resumption of a balanced diet. The prognoses were good, with no mortalities. Conclusions: lactation ketoacidosis should be suspected in unwell breastfeeding women with high anion gap metabolic acidosis, after excluding other causes. View Full-Text
Keywords: lactation ketoacidosis; bovine ketoacidosis; lactation ketonemia; breastfeeding; high anion gap metabolic acidosis; ketosis; starvation lactation ketoacidosis; bovine ketoacidosis; lactation ketonemia; breastfeeding; high anion gap metabolic acidosis; ketosis; starvation
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Al Alawi, A.M.; Al Flaiti, A.; Falhammar, H. Lactation Ketoacidosis: A Systematic Review of Case Reports. Medicina 2020, 56, 299.

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