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Severe metabolic ketoacidosis as a primary manifestation of SARS-CoV-2 infection in non-diabetic pregnancy
  1. Jojanneke Epke van Amesfoort,
  2. Dominique E Werter,
  3. Rebecca C Painter and
  4. Frederik J R Hermans
  1. Obstetrics & Gynaecology, Amsterdam UMC Location AMC, Amsterdam, North Holland, The Netherlands
  1. Correspondence to Jojanneke Epke van Amesfoort; j.e.vanamesfoort{at}


We present a case of a metabolic acidosis in a term-pregnant woman with SARS-CoV-2 infection.

Our patient presented with dyspnoea, tachypnoea, thoracic pain and a 2-day history of vomiting, initially attributed to COVID-19 pneumonia. Differential diagnosis was expanded when arterial blood gas showed a high anion gap metabolic non-lactate acidosis without hypoxaemia. Most likely, the hypermetabolic state of pregnancy, in combination with maternal starvation and increased metabolic demand due to infection, had resulted in metabolic ketoacidosis. Despite supportive treatment and rapid induction of labour, maternal deterioration and fetal distress during labour necessitated an emergency caesarean section. The patient delivered a healthy neonate. Postpartum, after initial improvement in metabolic acidosis, viral and bacterial pneumonia with subsequent significant respiratory compromise were successfully managed with oxygen supplementation and corticosteroids. This case illustrates how the metabolic demands of pregnancy can result in an uncommon presentation of COVID-19.

  • COVID-19
  • metabolic disorders
  • pregnancy

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  • Contributors All authors provided clinical support for the patient mentioned and assisted in the writing of this manuscript. All authors approved the final version of this manuscript. Both JvA and DW contributed equally to this manuscript and therefore share first authorship.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.