Abstract
AimTo describe the clinical characteristics and outcome of hospitalized COVID-19 patients with diabetic ketoacidosis (DKA).MethodsWe report eight cases of diabetic ketoacidosis in COVID-19 who presented to our institution in New Jersey, USA. COVID-19 was diagnosed by nasopharyngeal swab reverse transcription polymerase chain reaction (RT-PCR). The patients' electronic medical records were reviewed. Data on patients' age, sex, ethnicity, laboratory values, glycosylated hemoglobin level, oral antihyperglycemic agents (OHAs), insulin, and clinical outcomes were collected.ResultsThe median age of the patient was 42.5 years, and seven were males and one was female. Out of eight patients, five had type 2 diabetes mellitus (DM), two had undiagnosed DM, and one had type 1 DM. Median value of initial glucose on presentation was 454 mg/dL. Median value of HbA1c on presentation was 11.4% and of anion gap was 26.5 mEq/L. Four patients had large ketonemia, one patient had moderate ketonemia, and three patients had small ketonemia. All the patients were started on standard treatment protocol for DKA with intravenous fluids and IV insulin infusion. Acute kidney injury (AKI) was seen in four patients, and one patient required renal replacement therapy. Out of eight patients, three required mechanical ventilation, and the same three patients died.ConclusionOur case series shows that COVID-19 infection can precipitate DKA in patients with known diabetes mellitus patients or as a first manifestation in undiagnosed DM patients; COVID-19 with DKA is associated with substantial mortality. Further studies are needed to characterize poor risk factors associated with mortality in these patients.
Highlights
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is an enveloped novel RNA betacoronavirus responsible for the current global pandemic
We report eight cases of diabetic ketoacidosis in COVID-19 who presented to our institution in New Jersey, USA
All the patients were started on standard treatment protocol for diabetic ketoacidosis (DKA) with intravenous fluids and IV insulin infusion
Summary
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is an enveloped novel RNA betacoronavirus responsible for the current global pandemic. In-depth understanding of various systemic manifestations and complications of SARS-CoV2 is of paramount importance for optimal management of these patients. Diabetes and obesity are common comorbidities associated with COVID-19 [1]. Comorbidities like cardiovascular disease, diabetes mellitus (DM), hypertension, chronic lung disease, cancer, chronic kidney disease, obesity, and smoking have been associated with severe illness and mortality [2,3]. A retrospective study from China found that high fasting glucose levels ≥ 126 mg/dl at admission was an independent poor prognostic factor in patients with COVID-19 who did not have diabetes mellitus [4]. A wide range of manifestations and outcome can occur depending upon the comorbidities of the infected patient. COVID-19 can precipitate metabolic complications of diabetes such as diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) [5]
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