Descriptive Study On Starvation Ketoacidosis In Covid-19 Obstetric Patients In A Tertiary Hospital in Central Region of Malaysia

PURPOSE: This study describes the presentation of starvation ketoacidosis in cases of pregnancy related Covid 19 pneumonia and their outcomes toward Cytokine Release Syndrome (CRS), Intensive Care Unit (ICU) admission, overall maternal and fetal outcome. METHODS & MATERIALS: Prospective study on all obstetric admissions for Covid 19 pneumonia in a tertiary hospital in central region of Malaysia (Hospital Ampang) from 1(st) July to 31(st) August 2021 was done. Starvation ketoacidosis cases as defined as serum bicarbonate less than 20mmol/L, with serum ketone of more than 3mmol/L or urine ketone more than 4+ were selected. Their outcome related to CRS, ICU admission and fetal outcome was monitor. Patients with incomplete data, and other cause of metabolic acidosis were excluded from this study. RESULTS: 31 patients been isolated to have starvation ketoacidosis based on our study criteria. The median age of our study population was 31 years old. Patients mostly presented in stable condition before the onset of starvation ketoacidosis whereby 23 cases (74.19%) presented with Category 1 to 3 Covid-19 infection and only 8 cases (25.81%) require oxygen (Category 4) on presentation. Starvation ketoacidosis has commonly been observed in gestational diabetes mothers (61.29%) and those with obesity (51.61%). It happened mostly at day 6 to day 10 of covid infection (54.83%) with commonly lower CRP count of less than 50 (61.29%) during onset of acidosis. The mean random blood sugar (RBS) among patients who diagnosed with starvation ketoacidosis was 5.95 mmol/L. Total of 25 from 31 patients (80.64 %) went into CRS, and required oxygen supplementation and 13 patients (41.94%) required ICU care. We also observed 21 out of 31 patients (67.74%) in our sample population whom needed delivery of the fetus CONCLUSION: Starvation ketoacidosis in Covid 19 Obstetric patients may precede CRS and ICU admission. The association of starvation ketoacidosis with CRS and ICU admission or worsening Covid 19 pneumonia need to be further evaluated in a bigger study sample. A prompt early multidisciplinary treatment involving Infectious Disease team, Intensive Care team and Obstetric Team could avoid undesirable patient outcome.