Thread by @obstetricmedic

Interestingly, I don't think they are entirely the same entity, so here is a mini-tweetorial on my thoughts about #COVID and #ketosis:

⭐️COVID has been associated with significant ketosis in non-pregnant pts
⭐️Not all COVID+ 🤰have the ⬇️oral intake seen in SK

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https://twitter.com/bethangoulden/status/1442586434641141761

⭐️Glucose is often normal / a bit high (rather than low/normal seen in SK)
⭐️Does not respond to glucose supplementation alone, often insulin needed, often higher doses than you would normally expect (fixed rate may be required)

But why worry?

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😱The associated acidosis / tachypnea may be mistaken for worsening COVID➡️potential increase in treatment and/or delivery
😟The compensation for acidosis may be lost if sedated/intubated ➡️ worsening in biochemistry when pt already sick

So the lesson here?

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⭐️Have a really low threshold for checking capillary ketones (urinary ketones lag behind and are not sufficient) in 🤰 with #COVID
⭐️Particularly if tachypnoeic / reduced oral intake
⭐️🧐at that gas! Look at the CO2/B ex / HCO3 (not just pH); they are v good at compensating

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⭐️Consider insulin if ketones trending upwards, may need fixed rate
⭐️Particularly worth watching for when giving maternal but particularly fetal steroids

So in conclusion, always #ThinkKetones in #COVIDinPregnancy

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