Starvation ketoacidosis (SKA) constitutes an important consideration in the pregnant patient who presents with profound metabolic
acidosis. Pregnancy-related changes predispose the patient to develop SKA following relatively short periods (12 - 14 hours) of ‘starvation’.
Patients also typically look clinically well in relation to the significant metabolic derangements that accompany the condition. Prompt
recognition and early institution of appropriate therapy is therefore extremely important in terms of optimising maternal and fetal outcome.
We describe a pregnant patient with SKA who presented with profound euglycaemic ketoacidosis that resolved rapidly following the early
initiation of appropriate therapy. Furthermore, appropriate therapy resulted in our patient avoiding the need for an emergency caesarean
section, which is often reported in this scenario. The ensuing discussion addresses SKA in pregnancy, the unique features of our patient,
and management considerations from a maternal and fetal perspective. We also discuss the various causes of ketoacidosis such as diabetic
ketoacidosis (DKA), euglycaemic DKA, alcohol-induced euglycaemic ketoacidosis and SKA in pregnant patients.