COVID-19-Induced Diabetic Ketoacidosis and Acute Respiratory Distress Syndrome in an Obese 24-Year-Old Type I Diabetic

Singh, Sukhdev; Foster, Allison; Khan, Zohaib; Siddiqui, Aisha; Atere, Muhammed; Nfonoyim, Jay

doi:10.12659/ajcr.925586

Cited by 6 publications

(6 citation statements)

References 17 publications

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“…In our review, males gender predominated development of DKA in SARS-CoV-2 patients, a finding suggested in most of the reports [ 11 – 13 , 15 – 17 , 19 , 20 , 23 , 25 , 26 , 31 , 33 , 36 , 37 , 39 , 47 , 50 , 52 , 55 – 58 , 60 – 64 , 69 , 74 , 75 ] and in contradiction with data from other reports suggesting an equal proportion of DKA cases in COVID-19 patients for both genders [ 30 , 34 , 38 , 49 ]. Lifestyle, body fat distribution, hormonal factors, susceptibility to glucotoxicity and lipotoxicity, and changes in insulin sensitivity have been described as potential factors of DKA and possible mechanisms of male predominance [ 88 ].…”

Section: Discussionsupporting

confidence: 62%

“…Among the included studies, 11 reported DKA and COVID-19 in children [ 8 , 11 , 22 , 30 , 34 , 44 , 45 , 56 , 61 , 66 , 72 ], 56 reported DKA and COVID-19 in adults [ 9 , 10 , 12 – 21 , 23 , 25 – 29 , 31 – 33 , 35 – 43 , 46 – 55 , 57 – 60 , 62 – 65 , 67 – 71 , 73 – 75 ], and only 1 study reported DKA and COVID-19 in both children and adults [ 24 ]. There were 54 case report [ 8 – 12 , 14 , 16 , 17 , 19 – 23 , 25 – 27 , 29 – 42 , 44 – 51 , 53 – 58 , 60 , 61 , 64 , 66 , 67 , 69 , 71 , 72 , 74 , 75 ], 10 case series [ 13 , 15 , 28 , 43 , 58 , 59 , 62 , 63 , 70 , 73 ...…”

Section: Resultsmentioning

confidence: 99%

“…The median or mean patient age ranged from < 1 years to 66 years across studies. There was an increased male predominance in DKA patients diagnosed with SARS-CoV-2 in most of the studies [n = 373, 58.4%] [ 9 – 13 , 15 – 17 , 19 , 20 , 23 , 25 , 26 , 31 – 33 , 36 , 37 , 39 , 45 , 47 , 50 – 52 , 55 – 58 , 60 – 64 , 67 – 69 , 74 , 75 ] and majority of the patients belonged to Hispanic (n = 156, 24.4%) and black (n = 98, 15.3%) ethnicity [ 14 – 16 , 18 , 19 , 21 , 24 , 27 , 28 , 44 – 46 , 54 , 57 , 58 , 62 , 63 , 65 , 68 , 75 ]. The median BMI for all included patients was 27.3 kg/m 2 [interquartile range (IQR) 24.8–30.6 kg/m 2 ].…”

Section: Resultsmentioning

confidence: 99%

“…The current meta-analysis is more comprehensive and included a total of 68 studies [ 8 – 75 ] including a total of 639 patients; whose details on final treatment outcome were available; in comparison to smaller sample size in previous meta-analyses [sample size: n = 45 and n = 21, respectively] [ 90 , 91 ]. The inclusion of 48 recently published studies [ 8 – 14 , 16 , 21 , 23 – 26 , 28 , 30 , 32 – 35 , 40 , 42 – 46 , 48 , 50 , 51 , 53 , 54 , 56 – 59 , 61 – 64 , 66 – 75 ] contributed to the refinement on evidence of the demographic, biochemical, and clinical characteristics; in addition to final therapy outcome in COVID-19 patients with DKA.…”

Section: Discussionmentioning

confidence: 99%

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Diabetic ketoacidosis in patients with SARS-CoV-2: a systematic review and meta-analysis

Alhumaid

Mutair

Alawi

et al. 2021

Diabetol Metab Syndr

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Background One possible reason for increased mortality due to SARS-CoV-2 in patients with diabetes is from the complication of diabetic ketoacidosis (DKA). Objectives To re-evaluate the association of SARS-CoV-2 and development of DKA and analyse the demographic and biochemical parameters and the clinical outcomes in COVID-19 patients with DKA. Design A systematic review and meta-analysis. Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement was followed. Methods Electronic databases (Proquest, Medline, Embase, Pubmed, CINAHL, Wiley online library, Scopus and Nature) were searched from 1 December 2019 to 30 June 2021 in the English language using the following keywords alone or in combination: COVID-19 OR SARS-CoV-2 AND diabetic ketoacidosis OR DKA OR ketosis OR ketonemia OR hyperglycaemic emergency OR hyperglycaemic crisis. We included studies in adults and children of all ages in all healthcare settings. Binary logistic regression model was used to explore the effect of various demographic and biochemical parameters variables on patient’s final treatment outcome (survival or death). Results Of the 484 papers that were identified, 68 articles were included in the systematic review and meta-analysis (54 case report, 10 case series, and 4 cohort studies). Studies involving 639 DKA patients with confirmed SARS-CoV-2 [46 (7.2%) were children and 334 (52.3%) were adults] were analyzed. The median or mean patient age ranged from < 1 years to 66 years across studies. Most of the patients (n = 309, 48.3%) had pre-existing type 2 diabetes mellitus. The majority of the patients were male (n = 373, 58.4%) and belonged to Hispanic (n = 156, 24.4%) and black (n = 98, 15.3%) ethnicity. The median random blood glucose level, HbA1c, pH, bicarbonate, and anion gap in all included patients at presentation were 507 mg/dl [IQR 399–638 mg/dl], 11.4% [IQR 9.9–13.5%], 7.16 [IQR 7.00–7.22], 10 mmol/l [IQR 6.9–13 mmol/l], and 24.5 mEq/l [18–29.2 mEq/l]; respectively. Mortality rate was [63/243, 25.9%], with a majority of death in patients of Hispanic ethnicity (n = 17, 27%; p = 0.001). The odd ratios of death were significantly high in patients with pre-existing diabetes mellitus type 2 [OR 5.24, 95% CI 2.07–15.19; p = 0.001], old age (≥ 60 years) [OR 3.29, 95% CI 1.38–7.91; p = 0.007], and male gender [OR 2.61, 95% CI 1.37–5.17; p = 0.004] compared to those who survived. Conclusion DKA is not uncommon in SARS-CoV-2 patients with diabetes mellitus and results in a mortality rate of 25.9%. Mortality key determinants in DKA patients with SARS-CoV-2 infection are individuals with pre-existing diabetes mellitus type 2, older age [≥ 60 years old], male gender, BMI ≥ 30, blood glucose level > 1000 mg/dl, and anion gap ≥ 30 mEq/l.

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Section: Discussionsupporting

confidence: 62%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Diabetic ketoacidosis in patients with SARS-CoV-2: a systematic review and meta-analysis

Alhumaid

Mutair

Alawi

et al. 2021

Diabetol Metab Syndr

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“…Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes COVID-19 pneumonia as well as extrapulmonary complication. There are a few cases of precipitation of new-onset diabetes and diabetes ketoacidosis associated with COVID-19 [3,4]. We present a case of a 44-year-old patient with COVID-19 and concomitant new onset of diabetes and severe diabetes ketoacidosis.…”

Section: Introductionmentioning

confidence: 94%

A Case of New Onset Diabetes and Severe Diabetes Ketoacidosis in a Patient With COVID-19

Patel¹,

Ayad²,

Rayad³

et al. 2021

Cureus

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Diabetic ketoacidosis (DKA) is a significant complication of poorly controlled diabetes. In diabetics, it typically occurs due to insulin deficiency resulting in lipolysis and subsequent ketone body formation and acidosis. The emergence of the COVID-19 infection has been associated with several complications, with the most prominent being pulmonary and cardiovascular-related. However, in some cases, patients with COVID-19 infection present with diabetic ketoacidosis. The pathophysiology of DKA in COVID-19 infection is different and currently not completely understood. The manifestation of DKA in COVID-19 patients is associated with increased severity of mortality and length of stay in these patients. Here, we describe a patient with no past medical history who presented with COVID-19 symptoms and was found to be in DKA. This case report highlights the possible underlying pathophysiology associated with this complication.

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Insulin/potassium/sodium-bicarbonate

2020

Reactions Weekly

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Insulin/potassium/sodium-bicarbonate Acute respiratory distress syndrome: case report A 24-year-old man developed fatal acute respiratory distress syndrome (ARDS) during treatment insulin for diabetic ketoacidosis (DKA), potassium for electrolyte replacement therapy and sodium-bicarbonate for myocardial protection from hyperkalaemia [not all routes and dosages stated]. The man who had history of mild obesity, diabetes mellitus type 1 and hyperlipidaemia, presented to the emergency Department (ED) for vomiting, nausea, and an episode of haematemesis. He was noncompliant with his medications. On physical examination, showed he had mild distress, lethargy, and had delayed responses to questioning. Various examinations were performed. He was admitted to the ICU and received unspecified fluids along with vancomycin, cefepime, infusion of sodium bicarbonate 150 mEq, potassium repletion 100mL, and IV infusion of insulin 6 units/hour. Based on the clinical findings, he was diagnosed with DKA and acute kidney injury. On day 2 of admission, he developed signs of respiratory distress. Subsequently, his nasopharyngeal swab result was positive for COVID-19. The decision was made to intubate and mechanically ventilate, given his worsening respiratory status. Respiratory improvement was demonstrated postintubation. A chest X-ray indicated probable COVID-19 pneumonia. Thus, on day 3 of admission, he received off label treatment with azithromycin and hydroxychloroquine for COVID-19. On day 4, his oxygen saturation again dropped and continued to desaturate on day 7. On day 8, a sputum culture returned with yeast isolates. At this time, cefepime and vancomycin were withdrawn and replaced with meropenem for a wider antibiotic coverage along with voriconazole for fungal infection. A chest X-ray revealed worsening of his bilateral infiltrates. He remained intermittently febrile on day 9 and had multiple desaturations. Arterial blood gasses showed worsening hypercapnia. Chest X-ray revealed diffuse fluffy infiltrates throughout bilateral lungs, consistent with ARDS. Later that day, despite full PEEP and FiO2, he desaturated to 50%. Subsequently, he developed severe hypotension, bradycardia and eventually became pulseless. An advanced cardiovascular life support was initiated. Unfortunately, he could not be resuscitated and died due to hypoxic respiratory failure secondary to COVID-19 complicated by ARDS. The development of ARDS was attributed to the use of insulin, potassium and sodiumbicarbonate [duration of treatments to reaction onset not stated].

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COVID-19-Induced Diabetic Ketoacidosis and Acute Respiratory Distress Syndrome in an Obese 24-Year-Old Type I Diabetic

Cited by 6 publications

References 17 publications

Diabetic ketoacidosis in patients with SARS-CoV-2: a systematic review and meta-analysis

Diabetic ketoacidosis in patients with SARS-CoV-2: a systematic review and meta-analysis

A Case of New Onset Diabetes and Severe Diabetes Ketoacidosis in a Patient With COVID-19

Insulin/potassium/sodium-bicarbonate

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