Low-carbohydrate diets have surged in popularity since their introduction in the 1960s, but patients may not be aware of the risks associated with a sharp decrease in carbohydrate consumption. A case study in the Journal of Medical Reports discusses a non-diabetic patient whose ketoacidosis was likely caused by the combination of a strict diet and breastfeeding.

A healthy non-diabetic 32-year-old woman was admitted to the hospital with nausea, vomiting, heart palpitations, trembling, and extremity spasms. She had started a strict low carbohydrate-high fat LCHF) diet 10 days prior and was breastfeeding her son, aged 10 months; her estimated carbohydrate intake per day was <20g. Past medical history included hypothyreosis and a family history of high blood pressure, but not diabetes. She took acetaminophen occasionally but no other medications and denied any alcohol or drug intake.

After an initial exam showed no abnormalities of the heart, lungs, abdomen, and thyroid gland, arterial blood gas showed pH 7.20, base excess (BE) −19, partial pressure of carbon dioxide (pCO 2 ) 2.8 kPa, glucose 3.8mmol/l and lactate 1.0mmol/l. Her blood ketones were also 7.1mmol/l (reference 0 to 0.5mmol/l). Based on this, the primary diagnosis was believed to be ketoacidosis due to starvation induced by the LCHF diet and the patient was given an intramuscular vitamin B injection and a 10% glucose infusion was initiated. Following glucose infusion and small doses of human insulin administered intravenously and insulin aspart subcutaneously the following day, acidosis was reversed. The patient was discharged and fully recovered.

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Based on the following information, ketoacidosis associated with a LCHF diet and lactation was the primary diagnosis:

  • Normal blood glucose and C-peptide, glycated hemoglobin (HbA1c) 37mmol/mol and negative autoantibodies
  • Normal kidney function
  • Thyroid tests normalized on one-month follow-up and thyroid peroxidase (TPO) antibodies were negative.
  • P-cortisol and adrenocorticotropic hormone (ACTH) levels were normal

Fasting, infections, lactating twins, and bariatric surgery have been associated with an increased risk of ketoacidosis, but this is the first reported case of the condition in a non-diabetic patient due to a LCHF diet and lactation. It is important to discuss with patients that dieting while breastfeeding is not recommended and can lead to ketoacidosis due to the high demand of substrate to produce milk.

For more information visit JMedicalCaseReports.com.