The Perfect Storm : Rapid Progression of Diabetic Ketoacidosis in Pediatric Diabetes in the Setting of COVID-19
© 2021 Published by Elsevier Inc. on behalf of the AACE..
OBJECTIVE: The coronavirus disease 2019 (COVID-19) pandemic has introduced countless challenges to the medical field. Although pediatric patients have been reported to have lower rates of COVID-19 mortality, the presence of pre-existing conditions can heighten the severity of their clinical presentation. This report discusses the potential influence COVID-19 might have on diabetic ketoacidosis.
METHODS: Our patient, a 6-year-old girl with known type 1 diabetes, presented with acute onset of abnormal breathing and altered mental status. The day prior, she had 1 episode of emesis, diarrhea, and abdominal pain but no fever. She presented to an outside hospital and was reported to have agonal breathing with a Glasgow Coma Scale score of 8 (eyes open to pain, no verbal response to stimuli, and localized pain). She was promptly intubated, and the initial laboratory tests revealed severe diabetic ketoacidosis (DKA). A family member had COVID-19, and she also tested positive for COVID-19.
RESULTS: Our patient's rapid progression and severity of illness require a discussion of how COVID-19 might affect diabetes and indicate opportunities for improving clinical practice in children with pre-existing diabetes. We discussed how COVID-19 might change the underlying pathophysiology of DKA and cause metabolic complications. Possible mechanisms include binding to angiotensin-converting enzyme 2 receptors and enabling a proinflammatory "cytokine storm." Additionally, ketoacidosis and altered mental status have been present in patients with COVID-19 without diabetes, which might potentiate the symptoms in developing DKA.
CONCLUSION: Prompt recognition of DKA is warranted, as caregivers may attribute the symptoms to COVID-19 rather than to DKA, resulting in an increased severity of illness on presentation with acute symptom onset, as described in this report.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2021 |
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| Erschienen: |
2021 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:7 |
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| Enthalten in: |
AACE clinical case reports - 7(2021), 6 vom: 19. Nov., Seite 357-359 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Modarelli, Rachel [VerfasserIn] |
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| Links: |
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| Anmerkungen: |
Date Revised 28.04.2022 published: Print-Electronic Citation Status PubMed-not-MEDLINE |
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| doi: |
10.1016/j.aace.2021.05.007 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM326528105 |
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| 100 | 1 | |a Modarelli, Rachel |e verfasserin |4 aut | |
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| 500 | |a Date Revised 28.04.2022 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status PubMed-not-MEDLINE | ||
| 520 | |a © 2021 Published by Elsevier Inc. on behalf of the AACE. | ||
| 520 | |a OBJECTIVE: The coronavirus disease 2019 (COVID-19) pandemic has introduced countless challenges to the medical field. Although pediatric patients have been reported to have lower rates of COVID-19 mortality, the presence of pre-existing conditions can heighten the severity of their clinical presentation. This report discusses the potential influence COVID-19 might have on diabetic ketoacidosis | ||
| 520 | |a METHODS: Our patient, a 6-year-old girl with known type 1 diabetes, presented with acute onset of abnormal breathing and altered mental status. The day prior, she had 1 episode of emesis, diarrhea, and abdominal pain but no fever. She presented to an outside hospital and was reported to have agonal breathing with a Glasgow Coma Scale score of 8 (eyes open to pain, no verbal response to stimuli, and localized pain). She was promptly intubated, and the initial laboratory tests revealed severe diabetic ketoacidosis (DKA). A family member had COVID-19, and she also tested positive for COVID-19 | ||
| 520 | |a RESULTS: Our patient's rapid progression and severity of illness require a discussion of how COVID-19 might affect diabetes and indicate opportunities for improving clinical practice in children with pre-existing diabetes. We discussed how COVID-19 might change the underlying pathophysiology of DKA and cause metabolic complications. Possible mechanisms include binding to angiotensin-converting enzyme 2 receptors and enabling a proinflammatory "cytokine storm." Additionally, ketoacidosis and altered mental status have been present in patients with COVID-19 without diabetes, which might potentiate the symptoms in developing DKA | ||
| 520 | |a CONCLUSION: Prompt recognition of DKA is warranted, as caregivers may attribute the symptoms to COVID-19 rather than to DKA, resulting in an increased severity of illness on presentation with acute symptom onset, as described in this report | ||
| 650 | 4 | |a Case Reports | |
| 650 | 4 | |a ACE2, angiotensin-converting enzyme 2 | |
| 650 | 4 | |a COVID-19 | |
| 650 | 4 | |a COVID-19, coronavirus disease 2019 | |
| 650 | 4 | |a DKA, diabetic ketoacidosis | |
| 650 | 4 | |a IL-6, interleukin 6 | |
| 650 | 4 | |a SARS-CoV, severe acute respiratory syndrome coronavirus | |
| 650 | 4 | |a diabetes | |
| 650 | 4 | |a diabetic ketoacidosis | |
| 650 | 4 | |a pediatrics | |
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| 700 | 1 | |a Hendrix, Grace |e verfasserin |4 aut | |
| 700 | 1 | |a DeRusso, Michelle |e verfasserin |4 aut | |
| 700 | 1 | |a Ozment, Caroline |e verfasserin |4 aut | |
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