1277-PUB: Severe DKA in Adolescent at Onset of Type 2 Diabetes and COVID-19

Abstract

Introduction: Obesity and type 2 diabetes (T2D) increase severity of SARS-CoV2 in adults. In one review of DKA and COVID-19 in adults, 77% had pre-existing diabetes while 10% were newly diagnosed. We report an adolescent with severe DKA and new onset T2D in the setting of COVID-19 infection, who had a complex hospital course. Case: A 14-year old male with BMI of 43.7 kg/m2 and learning disabilities presented with decreased mental status and 4 day history of polydipsia, polyuria and emesis. Initial labs: glucose 546 mg/dl, BOHB 4.4 mmol/L, venous pH 6.94, HCO3 3mmol/L, serum osm 287 mOsm/kg, A1C 12.3%, pancreatic antibodies negative. C-reactive protein, d-dimer, ferritin, CPK, troponin, lipase (4,610 U/L), and amylase (839 U/L) were elevated. Patient received mannitol. No cerebral edema on head CT. Chest/Abd CT showed bilateral lower lobe consolidation of lungs and heterogeneous pancreas with no fluid collection. IV fluids and insulin were started. Nine hours after presentation, mental status declined further and patient required intubation for respiratory failure. At 19 hours, ketosis had resolved but acidosis persisted with arterial pH=7.05. SARS-CoV-2 nasopharyngeal swab PCR was positive. Course was complicated by multi-organ failure, rhabdomyolysis, and fluid refractory shock requiring vasopressors and renal replacement therapy (max creatinine 5.13 mg/dL). Patient started anticoagulant therapy, but on day 12 left femoral DVT was diagnosed. On hospital day 20 a retroperitoneal hemorrhage was noted. Inflammatory markers normalized by day 43. The patient had significant neurologic deficits and required prolonged rehabilitation after discharge on hospital day 46. Conclusion: To our knowledge, this case of a morbidly obese adolescent with neurocognitive delays, is the first report of an adolescent with COVID-19 presenting with new onset T2D and DKA, who had a hospital course similar in severity to those reported in adult patients. Adolescents with T2D and SARS-CoV2 infection should be monitored for severe disease. Disclosure M. Baby: None. M. S. Litao: None. H. R. Dapul: None. B. Franklin: None. M. Gallagher: None.