Abstract
BackgroundMaldives reported its first Coronavirus disease 2019 (COVID-19) case on March 7th, 2020. Since then more than 9400 positive cases and 33 deaths have been reported. Recently studies have shown that COVID-19 patients with diabetes had a poor prognosis and a higher mortality rate when compared to the non-diabetic patients. Poorly controlled diabetic patients had a higher incidence of complications like diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) which might have been precipitated by COVID-19. DKA and HHS are potentially lethal but preventable conditions. During this pandemic, although cases of uncontrolled diabetes are frequently reported, there is scarcity in reporting of cases with diabetic emergencies.Case presentationCase 1 was a 53-year old Asian male, admitted on Day 10th of illness with DKA with acute kidney injury, and Moderate COVID-19. Case 2 was a 72-year old Asian male, admitted with mild COVID-19 who developed HHS with acute kidney injury on day 9 of illness. Both patients were managed conservatively in intensive care unit, with intravenous fluids and insulin.ConclusionClinicians should focus on close monitoring of diabetic patients with COVID-19, to prevent diabetic emergencies like DKA and HHS. It is important to aggressively manage these conditions for a favorable outcome.
Highlights
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak began in China in December 2019 [1]
Clinicians should focus on close monitoring of diabetic patients with COVID-19, to prevent diabetic emergencies like diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS)
We have described two cases of diabetic emergencies precipitated by COVID-19
Summary
It is important for physicians to be vigilant in diabetic patients admitted with COVID-19 as they are at increased risk of developing complications. Diabetic emergencies like DKA and HHS can be precipitated by COVID-19 infection, and if not recognized early and treated promptly, it may lead to catastrophic outcomes. Clinicians should focus on close monitoring of diabetic patients with COVID-19, to prevent diabetic emergencies like diabetic ketoacidosis and hyperosmolar hyperglycemic state. As diabetes and COVID-19 are both highly prevalent in the Maldives, a high degree of suspicion is required to diagnose diabetic ketoacidosis and hyperosmolar hyperglycemic state timely for a better prognosis. In patients who develop diabetic emergencies, the intravenous fluid should be used judiciously with careful attention to markers of perfusion, to prevent volume overload and pulmonary edema
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