Euglycemic diabetic ketoacidosis in a patient with type 1 diabetes and SARS-CoV-2 pneumonia: case-report and review of the literature

Oriot, Philippe; Hermans, Michel P.

doi:10.1080/17843286.2020.1780390

Cited by 31 publications

(31 citation statements)

References 22 publications

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“… e Patients with black ethnicity include African-American, Black African, African and Afro-Caribbean patients. f Individual data on type of diabetes were available in 97 patients from 15 studies [ 7 , [9] , [10] , [11] , [12] , [13] , [14] , 16 , [18] , [19] , [20] , [22] , [23] , [24] , 28 ]. g Use of SGLT2 inhibitors was reported in 7 patients from 5 studies [ [9] , [10] , [11] , 13 , 22 ].…”

Section: Resultsmentioning

confidence: 99%

“… c Individual data on patient sex were available in 102 patients from 18 studies [ [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , 28 ]. …”

Section: Resultsmentioning

confidence: 99%

“… g Use of SGLT2 inhibitors was reported in 7 patients from 5 studies [ [9] , [10] , [11] , 13 , 22 ]. …”

Section: Resultsmentioning

confidence: 99%

“…As with other severe infections [ 6 ], diabetic ketoacidosis (DKA) has been reported in patients with COVID-19 [ [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] ]. With regard to coronaviruses, it has been shown that SARS-CoV (responsible for the SARS outbreak in 2003) binds to ACE2 in the pancreatic islets leading to islet damage and acute diabetes [ 25 ].…”

Section: Introductionmentioning

confidence: 99%

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Clinical profile and outcomes in COVID-19 patients with diabetic ketoacidosis: A systematic review of literature

Pal

Banerjee

Yadav

et al. 2020

Diabetes & Metabolic Syndrome: Clinical Research & Revi

102

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Background and aim To conduct a systematic literature review and analyze the demographic/biochemical parameters and clinical outcomes of COVID-19 patients with diabetic ketoacidosis (DKA) and combined DKA/HHS (hyperglycemic hyperosmolar syndrome). Methods PubMed, Scopus, Embase, and Google Scholar databases were systematically searched till August 3, 2020 to identify studies reporting COVID-19 patients with DKA and combined DKA/HHS. A total of 19 articles reporting 110 patients met the eligibility criteria. Results Of the 110 patients, 91 (83%) patients had isolated DKA while 19 (17%) had DKA/HHS. The majority of the patients were male (63%) and belonged to black ethnicity (36%). The median age at presentation ranged from 45.5 to 59.0 years. Most of the patients (77%) had pre-existing type 2 diabetes mellitus. Only 10% of the patients had newly diagnosed diabetes mellitus. The median blood glucose at presentation ranged from 486.0 to 568.5 mg/dl, being higher in patients with DKA/HHS compared to isolated DKA. The volume of fluid replaced in the first 24 h was higher in patients with DKA/HHS in contrast to patients with DKA alone. The in-hospital mortality rate was 45%, with higher mortality in the DKA/HHS group than in the isolated DKA group (67% vs. 29%). pH was lower in patients who had died compared to those who were discharged. Conclusion DKA in COVID-19 patients portends a poor prognosis with a mortality rate approaching 50%. Differentiating isolated DKA from combined DKA/HHS is essential as the latter represents nearly one-fifth of the DKA cases and tends to have higher mortality than DKA alone.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“… g Use of SGLT2 inhibitors was reported in 7 patients from 5 studies [ [9] , [10] , [11] , 13 , 22 ]. …”

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Clinical profile and outcomes in COVID-19 patients with diabetic ketoacidosis: A systematic review of literature

Pal

Banerjee

Yadav

et al. 2020

Diabetes & Metabolic Syndrome: Clinical Research & Revi

102

View full text Add to dashboard Cite

show abstract

“…There are two case reports of eu-DKA in the setting of SARS-CoV-2 infection and SGLT2 inhibitor use [ 17 , 21 ], but we would like to emphasize some differences this report presents. The first difference is that the patient investigated in the present case report has T2DM and developed eu-DKA even without being on previous use of insulin.…”

Section: Discussionmentioning

confidence: 99%

COVID-19-associated euglycemic diabetic ketoacidosis in a patient with type 2 diabetes on SGLT2 inhibitor: a case report

et al. 2020

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Type 2 diabetes mellitus (DM) patients are at high risk for the development of severe COVID-19. Euglycemic diabetic ketoacidosis (eu-DKA) is a rare life-threatening complication associated with the use of SGLT2 inhibitor that may be unnoticed, particularly in a pandemic setting, due to the absence of significant hyperglycemia, delaying its treatment. In this report, we describe a case of a 56-year-old patient who presented an elevated anion gap metabolic acidosis during a SARS-CoV-2 infection and was diagnosed with SGLT2-associated euglycemic diabetic ketoacidosis. COVID-19 may increase patients’ insulin demand, present gastrointestinal symptoms, and increase the production of ketone bodies. This situation can be worsened in susceptible diabetic patients on SLGT2 inhibitors, due to the persistent glycosuria, which can cause volume depletion. Recently some authors recommended that insulin-deficient patients or those using SGLT2 inhibitors should monitor for ketosis using available home testing kits in case of infections and should discontinue the medication in case of COVID-19. Given the increased use of this drug class in the management of type 2 DM patients due to its reduction of cardiovascular risk, we set out to emphasize the importance for the medical community to consider the possibility of eu-DKA on SARS-CoV-2-infected patients using SLGT2 inhibitors, so physicians can provide these patients with appropriate therapy promptly.

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Invasive Fungal Infections in Dengue Recovered Patients: A New Phenomenon in the Covid-19 Era

Singhal

Rawat

Sharma

et al. 2022

Indian J Otolaryngol Head Neck Surg

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Invasive fungal rhinosinusitis was seen to rise to epidemic levels after the 2nd wave of ongoing Covid pandemic, especially in tropical countries, maximally in India. A similar trend is being observed for cases who have recently recovered from dengue virus infection. Post dengue invasive fungal infection is a new presentation and any associations between it and Covid pandemic need to be studied in detail to help prepare for any complications. 3 patients presented to the out-patient department of E.N.T at a tertiary level teaching hospital in East India with complains similar to rhinosinusitis. These patients were then evaluated and diagnosed to be infected from Mucormycosis and Aspergillosis fungal sinusitis after which they were managed with surgical debridement and systemic antifungal therapy. All had a recent history of recovery from Dengue virus infection and a possible association could be suspected. 3 patients presented with complains of pain over upper jaw with orbital swelling and loss of vision developing over a period of 24 days. Two of them had ulceration of hard palate. They were then subjected to Contrast MRI along with CT scan of the Paranasal sinuses which depicted pansinus involvement with intracranial extension in two patients. These were then planned for diagnostic nasal endoscopies along with biopsies which turned out to be Invasive fungal sinusitis in the form of Aspergillosis and Mucormycosis. All the 3 patients had recent history of recovery from Dengue virus infection and did not have any other co-morbidities. Covid Associated Mucormycosis (CAM) is a well-known entity now but no reports of Dengue associated Invasive fungal sinusitis are yet reported. Whether this new phenomenon has anything to do with the interactions between dengue virus and coronavirus is not known at present and needs to be studied in detail so appropriate management protocols can be formulated.

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Euglycemic diabetic ketoacidosis in a patient with type 1 diabetes and SARS-CoV-2 pneumonia: case-report and review of the literature

Cited by 31 publications

References 22 publications

Clinical profile and outcomes in COVID-19 patients with diabetic ketoacidosis: A systematic review of literature

Clinical profile and outcomes in COVID-19 patients with diabetic ketoacidosis: A systematic review of literature

COVID-19-associated euglycemic diabetic ketoacidosis in a patient with type 2 diabetes on SGLT2 inhibitor: a case report

Invasive Fungal Infections in Dengue Recovered Patients: A New Phenomenon in the Covid-19 Era

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