Abstract:
Lactation ketoacidosis is becoming an increasingly recognised phenomenon. We present the case of a 32-year-old female, 5 months post-partum, who presented with lethargy, nausea and abdominal pain. She was a fitness instructor and still breastfeeding. 48 hours prior to admission, she had worked double training shifts involving high intensity exercise and due to time constraints had reduced her oral intake. Initial blood tests revealed a high anion gap metabolic acidosis with hypoglycaemia [pH 7.26 (normal 7.30–7.40), bicarbonate 12.3 mmol/L (normal 21.0–28.0), anion gap 14.7 mmol/L (normal 8–12), glucose 2.9 mmol/L (normal fasting 3.9–5.8) and ketones 4.8 mmol/L (normal <0.6)). She had no known diabetes. She was treated with IV dextrose and other causes of hypoglycaemia were excluded. She had complete recovery within 24 hours with resolution of her ketoacidosis. She was discharged home with the diagnosis of lactation ketoacidosis and remained well on a balanced diet with advice on limiting high intensity exercise while breastfeeding. Her lactation ketoacidosis was believed to be triggered by reduced carbohydrate intake and increased high intensity exercise while breastfeeding. We explore the literature surrounding this increasingly identified phenomenon.