Skip to main content

Thank you for visiting You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Ketoacidosis in a non-diabetic lactating woman: A case report and literature review


We report the case of a 36-year-old woman who developed non-diabetic ketoacidosis following a low carbohydrate diet in order to lose weight while actively breast feeding her newborn. She was admitted in intensive care unit because of severe metabolic acidosis. She rapidly recovered after refeeding process. Lactation ketoacidosis, a special condition that occurs in non-diabetic breastfeeding women, is rare and life-threatening. This report highlights the importance of nutritional education of lactating women in the post-partum period.

This is a preview of subscription content, access via your institution

Access options

Buy article

Get time limited or full article access on ReadCube.


All prices are NET prices.


  1. Al Alawi AM, Al Flaiti A, Falhammar H. Lactation ketoacidosis: a systematic review of case reports. Medicine 2020;56:299.

    Google Scholar 

  2. McArt JAA, Nydam DV, Oetzel GR. Epidemiology of subclinical ketosis in early lactation dairy cattle. J Dairy Sci. 2012;95:5056–66.

    Article  CAS  Google Scholar 

  3. Blanco JC, Khatri A, Kifayat A, Cho R, Aronow WS. Starvation ketoacidosis due to the ketogenic diet and prolonged fasting – a possibly dangerous diet trend. Am J Case Rep. 2019;20:1728–31.

    Article  Google Scholar 

  4. Song R, Cao S. Post-bariatric surgery starvation ketoacidosis and lipase elevation in the absence of DKA or pancreatitis. Am J Emerg Med. 2018;36:525.e3–525.e5.

    Article  Google Scholar 

  5. Lulsegged A, Saeed E, Langford E, Duffield C, El-Hasani S, Pareek N. Starvation ketoacidosis in a patient with gastric banding. Clin Med (Lond). 2011;11:473–5.

    Article  CAS  Google Scholar 

  6. Chausse JM, Paruk F, Motilall S, Soma-Pillay P, Ndaba S. Starvation ketoacidosis in pregnancy presenting as euglycaemic, high anion gap metabolic acidosis: a case report highlighting the significance of early recognition and prompt intervention. South Afr Med J. 2018;108:636.

    Article  CAS  Google Scholar 

  7. Frise C, Attwood B, Watkinson P, Mackillop L. Life-threatening ketoacidosis in a pregnant woman with psychotic disorder. Obstet Med. 2016;9:46–9.

    Article  Google Scholar 

  8. Hui L, Shuying L. Acute starvation ketoacidosis in pregnancy with severe hypertriglyceridemia: a case report. Medicine (Baltim). 2018;97:e0609–e0609.

    Article  Google Scholar 

  9. Sinha N, Venkatram S, Diaz-Fuentes G. Starvation ketoacidosis: a cause of severe anion gap metabolic acidosis in pregnancy. Case Rep. Crit Care. 2014;2014:906283–906283.

    PubMed  PubMed Central  Google Scholar 

  10. Wei K-Y, Chang S-Y, Wang S-H, Su H-Y, Tsai C-L. Short-term starvation with a near-fatal asthma attack induced ketoacidosis in a nondiabetic pregnant woman: a case report. Medicine (Baltim). 2016;95:e4042–e4042. juillet

    Article  Google Scholar 

  11. Chernow B, Finton C, Rainey TG, O’Brian JT. “Bovine ketosis” in a nondiabetic postpartum woman. Diabetes Care. 1982;5:47–9.

    Article  CAS  Google Scholar 

  12. Heffner AC, Johnson DP. A Case of Lactation “Bovine” Ketoacidosis. J Emerg Med. 2008;35:385–7.

    Article  Google Scholar 

  13. Sandhu HS, Michelis MF, DeVita MV. A case of bovine ketoacidosis in a lactating woman. Clin Kidney J. 2009;2:278–9.

    Article  Google Scholar 

  14. Szulewski A, Howes D, Morton AR. A severe case of iatrogenic lactation ketoacidosis. BMJ Case Rep. 2012;2012:bcr1220115409.

    Article  Google Scholar 

  15. Hudak SK, Overkamp D, Wagner R, Häring H-U, Heni M. Ketoacidosis in a non-diabetic woman who was fasting during lactation. Nutr J. 2015;14:117–117.

    Article  Google Scholar 

  16. von Geijer L, Ekelund M. Ketoacidosis associated with low-carbohydrate diet in a non-diabetic lactating woman: a case report. J Med Case Rep. 2015;9:224–224.

    Article  Google Scholar 

  17. Wuopio J, Schiborr R, Charalampakis G. Severe ketoacidosis in breastfeeding woman with low energy and carbohydrate intake. Lakartidningen. 2015;112.

  18. Monnier D, Goulenok T, Allary J, Zarrouk V, Fantin B. Cétose de jeûne chez une femme allaitante. La Rev de Médecine Interne. 2015;36:854–8.

    Article  CAS  Google Scholar 

  19. Gleeson S, Mulroy E, Clarke DE. Lactation ketoacidosis: an unusual entity and a review of the literature. Perm J. 2016;20:71–3.

    PubMed  PubMed Central  Google Scholar 

  20. Greaney DJ, Benson P Life-Threatening Lactation or “Bovine” Ketoacidosis: A Case Report. A&A Practice [Internet]. 2016;7. Available from:

  21. Sloan G, Ali A, Webster J. A rare cause of metabolic acidosis: ketoacidosis in a non-diabetic lactating woman. Endocrinol Diabetes Metab Case Rep. 2017;2017:17–0073.

    PubMed  PubMed Central  Google Scholar 

  22. Chew MS, Dalesjö L. Life-threatening ketoacidosis in a lactating woman. Eur J Anaesthesiol. 2018;35:984–6.

    Article  Google Scholar 

  23. Al Alawi AM, Falhammar H. Lactation ketoacidosis: case presentation and literature review. BMJ Case Reports. 2018;bcr-2017-223494.

  24. Azzam O, Prentice D. Lactation ketoacidosis: an easily missed diagnosis. Intern Med J. 2019;49:256–9.

    Article  Google Scholar 

  25. Nnodum BN, Oduah E, Albert D, Pettus M. Ketogenic diet-induced severe ketoacidosis in a lactating woman: a case report and review of the literature. Case Rep Nephrol. 2019;2019:1214208.

    PubMed  PubMed Central  Google Scholar 

  26. Seaton C, Sutherly K, Miller MA. Breastfeeding ketoacidosis: a rare but important diagnosis for emergency physicians to recognize. Am J Emerg Med. 2019;37:374.e1.

    Article  Google Scholar 

  27. Al Alawi AM, Al Amri U, Falhammar H. Lactation Ketoacidosis: a case series. Sultan Qaboos Univ Med J. 2019;19:359.

    Article  Google Scholar 

Download references


No financial assistance was received in support of the study.

Author information

Authors and Affiliations



AK and EL wrote the manuscript. CRL, AR, SC, BR, and JP provided feedback on the report.

Corresponding author

Correspondence to Emmanuel Lafont.

Ethics declarations

Competing interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Kachaner, A., Rives-Lange, C., Radu, A. et al. Ketoacidosis in a non-diabetic lactating woman: A case report and literature review. Eur J Clin Nutr 76, 775–777 (2022).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


Quick links