Images of the month: An incidental finding of spontaneous pneumomediastinum (Hamman's syndrome) secondary to diabetic ketoacidosis during the coronavirus pandemic

Marchon, Keisha A; Nunn, Maya; Chakera, Ali J.

doi:10.7861/clinmed.2020-0739

Cited by 8 publications

(7 citation statements)

References 4 publications

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“…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 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: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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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“…Son los pacientes diabéticos jóvenes en los cuales se ha reportado la mayoría de casos, siendo el diagnostico diferencial más importante a tener en cuenta el síndrome de Boerhaaver o rotura esofágica el cual tiene alta mortalidad, pero fue descartado en nuestro paciente. 5,11 REFERENCIAS BIBLIOGRÁFICAS…”

Section: Discussionunclassified

“…Esto refuerza el curso benigno y autolimitado de esta entidad, lo que genera el infradiagnostico y que en la mayoría de los casos pase desapercibido. 11,12 PRESENTACIÓN DEL CASO Paciente varón de 15 años de edad, con antecedente de orquidopexia bilateral a los 6 años de edad, sin otros antecedentes patológicos de importancia. Ingresó con un tiempo de enfermedad de siete días, caracterizado por polidipsia, dolor abdominal en epigastrio tipo ardor de moderada intensidad, asociado a náuseas y vómitos de contenido bilioso, sin fiebre, Acudió a diferentes centros de salud donde le indicaron manejo sintomático, con mejoría parcial de los síntomas.…”

Section: Introductionunclassified

Neumomediastino espontaneo en un adolescente con cetoacidosis diabética

Sánchez-Morillos,

Espino-Graña

2023

spmi

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Un adolescente de 15 años sin antecedentes médicos significativos ingresó en el Servicio de Emergencia por polidipsia, dolor abdominal, náuseas, vómitos, disnea súbita y dolor torácico. Al ingreso se le diagnosticó cetoacidosis diabética además de penumomediastino espontáneo por tomografía. Se destaca que el neumomediastino asociado a cetoacidosis es una complicación rara pero con evolución favorable en la mayoría de los casos.

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“…[11] After correcting acidosis and vomiting, the pathological collection of air is gradually reabsorbed. [12,13] Therefore, the treatment for this condition is mainly supportive.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous pneumomediastinum in diabetic ketoacidosis: A case series of 10 patients

Xu¹,

Sun²,

Zang³

et al. 2022

World Journal of Emergency Medicine

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Images of the month: An incidental finding of spontaneous pneumomediastinum (Hamman's syndrome) secondary to diabetic ketoacidosis during the coronavirus pandemic

Cited by 8 publications

References 4 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

Neumomediastino espontaneo en un adolescente con cetoacidosis diabética

Spontaneous pneumomediastinum in diabetic ketoacidosis: A case series of 10 patients

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