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Introduction <p>Starvation ketoacidosis (SKA) in pregnant mothers is a rare condition characterized by high anion gap metabolic acidosis (HAGMA) with ketonaemia or ketonuria precipitated by a period of starvation.</p> Case Report <p>A 32-year-old woman, who was pregnant for the third time with past two miscarriages, presented at 13&#xa0;weeks of gestation with a 3-week history of dysphagia. This was accompanied by nausea and vomiting since the beginning of her pregnancy. To note, she was initially referred from a private institution with a new diagnosis of myasthenia gravis in impending myasthenic crisis. Upon presentation, her blood gas report revealed severe high anion gap metabolic acidosis (HAGMA) and ketonemia, which resolved quickly after the administration of dextrose and insulin infusion, along with a single dose of sodium bicarbonate bolus. This was followed by elective intubation in the intensive care unit due to respiratory distress caused by a myasthenic crisis.</p> Conclusion <p>This vignette emphasizes the importance of early recognition of SKA, and the urgency in returning the metabolic milieu to normality when the risk of further clinical deterioration is imminent. Furthermore, this report represents the first reported case of SKA that occurred during the first trimester.</p>

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A Rare Case of Starvation Ketoacidosis with Impending Myasthenia Crisis in the First Trimester—A Case Report

  • 期刊论文

  • 发表日期：

    2025年8月12日

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  • Thai Lun Tan,
  • Aaron Yeoh Yi Zhe,
  • Pei Sun Tan,
  • Ramadevi A/P Chardiasekaran

摘要

Introduction

Starvation ketoacidosis (SKA) in pregnant mothers is a rare condition characterized by high anion gap metabolic acidosis (HAGMA) with ketonaemia or ketonuria precipitated by a period of starvation.

Case Report

A 32-year-old woman, who was pregnant for the third time with past two miscarriages, presented at 13 weeks of gestation with a 3-week history of dysphagia. This was accompanied by nausea and vomiting since the beginning of her pregnancy. To note, she was initially referred from a private institution with a new diagnosis of myasthenia gravis in impending myasthenic crisis. Upon presentation, her blood gas report revealed severe high anion gap metabolic acidosis (HAGMA) and ketonemia, which resolved quickly after the administration of dextrose and insulin infusion, along with a single dose of sodium bicarbonate bolus. This was followed by elective intubation in the intensive care unit due to respiratory distress caused by a myasthenic crisis.

Conclusion

This vignette emphasizes the importance of early recognition of SKA, and the urgency in returning the metabolic milieu to normality when the risk of further clinical deterioration is imminent. Furthermore, this report represents the first reported case of SKA that occurred during the first trimester.