Severe ketoacidosis in a non-diabetic lactating woman on a ketogenic diet


  • John Alexander Mid Yorkshire NHS Hospitals Trust, Wakefield
  • Dinesh Nagi Mid Yorkshire NHS Hospitals Trust, Wakefield



diabetes mellitus, ketosis, ketoacidosis, ketogenic diet, non-diabetic ketoacidosis


Ketogenic diets are high fat, moderate protein, low carbohydrate diets with carbohydrate content usually less than 50 g/day. They are a novel intervention in the management of obesity and there is emerging evidence that they are very effective. Evidence regarding the long-term efficacy and safety of this rather new and popular intervention is still emerging and there is a lack of data on the effect of this diet in specific populations such as breast feeding women. We describe a case of severe ketoacidosis in a non-diabetic breast feeding woman who was successfully treated with conservative measures. This case highlights the need by medical and dietetic professionals for extra caution in initiating special dietary measures in susceptible physiological states.

Author Biographies

John Alexander, Mid Yorkshire NHS Hospitals Trust, Wakefield

Specialist Registrar in Endocrinology and Diabetes

Dinesh Nagi, Mid Yorkshire NHS Hospitals Trust, Wakefield

Consultant in Endocrinology and Diabetes


Gleeson S. Lactation ketoacidosis: an unusual entity and a review of the literature. Perm J 2016;20(1):71–3.

Holtenius P, Holtenius K. New aspects of ketone bodies in energy metabolism of dairy cows: a review. Zentralbl Veterinarmed A 1996;43(1–10):579–87.

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.

Nnodum B, 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.

Basnet S, Tachamo N, Nazir S, Dhital R, Jehangir A, Donato A. Severe anion gap metabolic acidosis associated with initiation of a very low-carbohydrate diet. J Community Hosp Intern Med Perspect 2019; 9(2):165–7.

Vining E. A multicenter study of the efficacy of the ketogenic diet. Arch Neurol 1998;55(11):1433–7.

Paoli A, Rubini A, Volek J, Grimaldi K. Beyond weight loss: a review of the therapeutic uses of very-low-carbohydrate (ketogenic) diets. Eur J Clin Nutr 2013;67(8):789–96.

Gomez-Arbelaez D, Crujeiras A, Castro A, et al. Acid–base safety during the course of a very low-calorie-ketogenic diet. Endocrine 2017; 58(1):81–90.

Yancy W, Olsen M, Dudley T, Westman E. Acid-base analysis of individuals following two weight loss diets. Eur J Clin Nutr 2007;61(12):1416–22.

Barski L, Eshkoli T, Brandstaetter E, Jotkowitz A. Euglycemic diabetic ketoacidosis. Eur J Intern Med 2019;63:9–14.






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