Article Text

Download PDFPDF
Lactation ketoacidosis: case presentation and literature review
  1. Abdullah M Al Alawi1,2,
  2. Henrik Falhammar3,4
  1. 1Royal Darwin Hospital, Casuarina, Australian Capital Territory, Australia
  2. 2Department of Medicine, Sultan Qaboos University, A’Seeb, Muscat, Oman
  3. 3Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Stockholm, Sweden
  4. 4Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
  1. Correspondence to Dr Abdullah M Al Alawi, dr.abdullahalalawi{at}


A 35-year-old woman presented to the emergency department with a 2 days history of malaise and headache. She was breastfeeding her 5-month old infant and had recently started an altered diet based on reducing carbohydrate amount. Moreover, she had also started exercising 2 weeks prior to her illness. Initial blood tests revealed high anion gap metabolic acidosis and hypoglycaemia (pH 7.13 (normal 7.30–7.40), bicarbonate 9.4 mmol/L (normal 21.0–28.0), anion gap 22.6 mmol/L (normal 8–12), glucose 2.9 mmol/L (normal fasting 3.9–5.8) and ketones 6.4 mmol/L (normal <0.6)). The patient was treated with intravenous dextrose and showed complete resolution of ketoacidosis and hypoglycaemia within 48 hours. She was discharged home and remained well with a balanced diet. After excluding all other the causes of hypoglycaemia and ketoacidosis, the diagnosis of lactation ketoacidosis was made and it was considered triggered by altered diet, exercise and skipping meals. All 11 cases of lactation ketoacidosis which has previously been published are reviewed as well.

  • endocrinology
  • metabolic disorders
View Full Text

Statistics from


  • Contributors AMAA: gathered clinical information, did part of literature review and wrote the first draft of the case report including creating table and figure. HF: helped with literature review, reviewed manuscript and provided expert opinion regarding inclusion of appropriate differentials and investigations. He reviewed the manuscript and added comments and suggestions.

  • 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.

  • Patient consent Obtained.

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

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.