18 October 2016
: Case report
Starvation Ketoacidosis as a Cause of Unexplained Metabolic Acidosis in the Perioperative Period
Unusual clinical course, Challenging differential diagnosis, Diagnostic / therapeutic accidents, Educational Purpose (only if useful for a systematic review or synthesis)
Monique MostertADEF, Anthony BonaviaDEFDOI: 10.12659/AJCR.900002
Am J Case Rep 2016; 17:755-758
Abstract
BACKGROUND: Besides providing anesthesia for surgery, the anesthesiologist’s role is to optimize the patient for surgery and for post-surgical recovery. This involves timely identification and treatment of medical comorbidities and abnormal laboratory values that could complicate the patient’s perioperative course. There are several potential causes of anion and non-anion gap metabolic acidosis in surgical patients, most of which could profoundly affect a patient’s surgical outcome. Thus, the presence of an acute acid-base disturbance requires a thorough workup, the results of which will influence the patient’s anesthetic management.
CASE REPORT: An otherwise-healthy 24-year-old female presented for elective spine surgery and was found to have metabolic acidosis, hypotension, and polyuria intraoperatively. Common causes of acute metabolic acidosis were investigated and systematically ruled out, including lactic acidosis, diabetic ketoacidosis, drug-induced ketoacidosis, ingestion of toxic alcohols (e.g., methanol, ethylene glycol), uremia, and acute renal failure. Laboratory workup was remarkable only for elevated serum and urinary ketone levels, believed to be secondary to starvation ketoacidosis. Due to the patient’s unexplained acid-base disturbance, she was kept intubated postoperatively to allow for further workup and management.
CONCLUSIONS: Starvation ketoacidosis is not widely recognized as a perioperative entity, and it is not well described in the medical literature. Lack of anesthesiologist awareness about this disorder may complicate the differential diagnosis for acute intraoperative metabolic acidosis and lead to a prolonged postoperative stay and an increase in hospital costs. The short- and long-term implications of perioperative ketoacidosis are not well defined and require further investigation.
Keywords: Acidosis, Fasting, ketosis
SARS-CoV-2/COVID-19
19 May 2022 : Case report
Am J Case Rep In Press; DOI: 10.12659/AJCR.936370
17 May 2022 : Case report
Am J Case Rep In Press; DOI: 10.12659/AJCR.936651
13 May 2022 : Case report
Am J Case Rep In Press; DOI: 10.12659/AJCR.936589
13 May 2022 : Case report
Am J Case Rep In Press; DOI: 10.12659/AJCR.936574
In Press
23 May 2022 : Case report
Am J Case Rep In Press; DOI: 10.12659/AJCR.935148
23 May 2022 : Case report
Am J Case Rep In Press; DOI: 10.12659/AJCR.936704
23 May 2022 : Case report
Am J Case Rep In Press; DOI: 10.12659/AJCR.936600
20 May 2022 : Case report
Am J Case Rep In Press; DOI: 10.12659/AJCR.936826
Most Viewed Current Articles
23 Feb 2022 : Case report
DOI :10.12659/AJCR.935250
Am J Case Rep 2022; 23:e935250
17 Feb 2022 : Case report
DOI :10.12659/AJCR.934399
Am J Case Rep 2022; 23:e934399
06 Dec 2021 : Case report
DOI :10.12659/AJCR.934406
Am J Case Rep 2021; 22:e934406
19 Feb 2022 : Case report
DOI :10.12659/AJCR.935355
Am J Case Rep 2022; 23:e935355