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e15510 Background: The SARS-CoV-2 (COVID-19) pandemic has had a lasting impact on the care of cancer patients. Multiple studies have shown that individuals with cancer are at high risk of serious complications in the setting of COVID-19 infection, but the impact in patients with gastrointestinal (GI) malignancies remain incompletely understood. We aimed to assess the impact of COVID-19 infection on mortality, length of stay (LOS), and cost of care among patients with GI malignancies, and identify differences in outcomes based on primary tumor site. Methods: We analyzed discharge encounters collected from the National Inpatient Sample (NIS) between March 2020 and December 2020, using propensity score-matching (PSM), and COVID- 19 as treatment effect. Results: Of the 87,684 patient discharges with GI malignancies, 1,892 were positive for COVID-19 (C+ve) and eligible for matching in the PSM model. Proportion for C+ve; male (61.2%), female (38.8%), White (55.8%), Black (17.9%), Hispanic (18.6%) and other (7.6%). Median age was 69 years (1QR: 61-77). Monthly variation reflected the wave and plateau dynamics of the spread of COVID-19. Following PSM analysis, C+ve patients with GI tumors demonstrated increased mortality compared to their COVID-19-negative (C-ve) counterparts (21.3% versus 11.9%, p < 0.001). C+ve patients with colorectal cancer (CRC) had significantly higher mortality compared to those who were C-ve; 39.95% [161/403] versus 24% [54/225], p = 0.035). In addition, C+ve patients with GI tumors had a longer LOS (9.42 days versus 6.95 days, p < 0.001) and increased cost of care ($26,048.29 versus $21,625.24, p = 0.001) compared to C-ve. Higher odds of mortality from myocardial infarction among C+ve(OR = 3.54, P = 0.001) while mortality due to pulmonary embolism or liver failure was not significantly different between C+ve and C-ve groups. Conclusions: This PSM analysis suggests that prior to the introduction of vaccines, C+ve patients with GI tumors faced approximately double the odds of mortality, an increased LOS of 2.5 days, and increased cost of care of about $4,400 compared to their C-ve counterparts. The disparity of outcomes was most pronounced among CRC patients. It is possible that the direct effects of the SARS-CoV-2 virus on the GI tract may predispose to mortality and disease severity, warranting further investigation. [Table: see text]

A 48-year-old male patient with Type 2 diabetes mellitus(T2D), on insulin replacement therapy, glipizide, and dapagliflozin presented with generalized weakness with weight loss of 40 pounds in 6 months ever since he was started on dapagliflozin. He was hemodynamically stable on arrival with a finger stick glucose of 121 gm%. Physical examination was unremarkable except for dry mucus How to cite this article: Matli VVK, Fariduddin MM, Asafo-Agyei KO, Bansal N. Normoglycemic diabetic ketoacidosis in a type 2 diabetes patient on dapagliflozin: A case report.

Introduction: A 65yr female presented to the hospital with complaints of pruritis and fatigue that had been ongoing for two months. Upon admission she was found to have transaminitis with AST and ALT at 392 and 400 respectively. (reference lab values AST 0-37 ; ALT 0-35) along with a total bilirubin of 25.1 mg/dL. (Ref 0-1.2). She reported that 1 month ago she went to a primary care doctor and was started on insulin, a calcium channel blocker and atorvastatin. A liver biopsy was done which revealed subacute liver injury-autoimmune pattern of injury (de novo versus secondary) 1/medication injury. This was confirmed by further positive autoimmune markers suggestive of autoimmune hepatitis. Case Description/Methods: The patient presented to the ER complaining of intense pruritis, dark urine, pale stools, and jaundice. She had recently started atorvastatin, amlodipine and insulin for newly diagnosed diabetes mellitus and essential hypertension. All home medications were stopped at admission except insulin. She had no prior history of liver disease and no family history of liver disease. She did not take any supplements and had never consumed alcohol. Initial labs revealed a transaminitis with AST and ALT at 392 and 400 IU/L respectively. (reference lab values AST 0-37 ; ALT 0-35 )along with alkaline phosphate at 2147 IU/L. . Initial imaging with a right upper quadrant ultrasound was normal. Patient continued to have a transaminitis and elevated alkaline phosphate that were not improving. A MRCP was done which showed hepatomegaly, mild periportal edema, slightly heterogenous enhancement-conglomerate of findings suggests nonspecific hepatitis. An EUS liver biopsy was performed which revealed subacute liver injury-autoimmune pattern of injury (de novo versus secondary) 1/medication injury. Additional laboratory testing revealed positive autoimmune markers; pointing to a drug induced autoimmune hepatitis as the likely diagnosis. Discussion: Patient was started on prednisone and discharged on a steroid taper once her liver function tests began to improve. She followed up in liver clinic and was noted to have developed hypercholesteremia with total cholesterol of 1,375 MG/DL (Ref 170-199 MG/DL), LDL of 1220 Mg/DL and HDL of 162 MG/DL. A cholesterol esters assay was ordered and referral for genetic testing made for likely acquired lecithin cholesterol acyltransferase deficiency in the setting of statin induced autoimmune hepatitis. Previous cholesterol tests prior to starting atorvastatin were normal.