Severe metabolic ketoacidosis- an unusual manifestation of C
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The corona virus pandemic and the associated illness have presented a challenge to clinicians. Clinicla menifestation is now known to vary from asymptomatic to respiratory failure and death. Despite rise in scientific advancements on understanding the virus, it has been a challenge unfolding its pathophysiology in pregnant women.

Doctors present a case of a metabolic acidosis in a term-pregnant woman with SARS-CoV-2 infection. The patient presented with dyspnoea, tachypnoea, thoracic pain and a 2-day history of vomiting, initially attributed to COVID-19 pneumonia.

Differential diagnosis was expanded when arterial blood gas showed a high anion gap metabolic non-lactate acidosis without hypoxaemia. Most likely, the hypermetabolic state of pregnancy, in combination with maternal starvation and increased metabolic demand due to infection, had resulted in metabolic ketoacidosis.

Despite supportive treatment and rapid induction of labour, maternal deterioration and fetal distress during labour necessitated an emergency caesarean section. The patient delivered a healthy neonate. Postpartum, after initial improvement in metabolic acidosis, viral and bacterial pneumonia with subsequent significant respiratory compromise were successfully managed with oxygen supplementation and corticosteroids.

This case illustrates how the metabolic demands of pregnancy can result in an uncommon presentation of COVID-19.