The Perfect Storm: Rapid Progression of Diabetic Ketoacidosis in Pediatric Diabetes in the Setting of COVID-19
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 presenta...
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Elsevier
2021
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oai:doaj.org-article:46ce631ad6d047d7b0ad7e71ed0f6ee42021-11-06T04:32:52ZThe Perfect Storm: Rapid Progression of Diabetic Ketoacidosis in Pediatric Diabetes in the Setting of COVID-192376-060510.1016/j.aace.2021.05.007https://doaj.org/article/46ce631ad6d047d7b0ad7e71ed0f6ee42021-11-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S2376060521000699https://doaj.org/toc/2376-0605Objective: 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.Rachel Modarelli, MDPinar Gumus Balikcioglu, MDGrace Hendrix, MDMichelle DeRusso, MDCaroline Ozment, MDElsevierarticleCOVID-19diabetesdiabetic ketoacidosispediatricsDiseases of the endocrine glands. Clinical endocrinologyRC648-665ENAACE Clinical Case Reports, Vol 7, Iss 6, Pp 357-359 (2021) |
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COVID-19 diabetes diabetic ketoacidosis pediatrics Diseases of the endocrine glands. Clinical endocrinology RC648-665 |
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COVID-19 diabetes diabetic ketoacidosis pediatrics Diseases of the endocrine glands. Clinical endocrinology RC648-665 Rachel Modarelli, MD Pinar Gumus Balikcioglu, MD Grace Hendrix, MD Michelle DeRusso, MD Caroline Ozment, MD The Perfect Storm: Rapid Progression of Diabetic Ketoacidosis in Pediatric Diabetes in the Setting of COVID-19 |
| description |
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. |
| format |
article |
| author |
Rachel Modarelli, MD Pinar Gumus Balikcioglu, MD Grace Hendrix, MD Michelle DeRusso, MD Caroline Ozment, MD |
| author_facet |
Rachel Modarelli, MD Pinar Gumus Balikcioglu, MD Grace Hendrix, MD Michelle DeRusso, MD Caroline Ozment, MD |
| author_sort |
Rachel Modarelli, MD |
| title |
The Perfect Storm: Rapid Progression of Diabetic Ketoacidosis in Pediatric Diabetes in the Setting of COVID-19 |
| title_short |
The Perfect Storm: Rapid Progression of Diabetic Ketoacidosis in Pediatric Diabetes in the Setting of COVID-19 |
| title_full |
The Perfect Storm: Rapid Progression of Diabetic Ketoacidosis in Pediatric Diabetes in the Setting of COVID-19 |
| title_fullStr |
The Perfect Storm: Rapid Progression of Diabetic Ketoacidosis in Pediatric Diabetes in the Setting of COVID-19 |
| title_full_unstemmed |
The Perfect Storm: Rapid Progression of Diabetic Ketoacidosis in Pediatric Diabetes in the Setting of COVID-19 |
| title_sort |
perfect storm: rapid progression of diabetic ketoacidosis in pediatric diabetes in the setting of covid-19 |
| publisher |
Elsevier |
| publishDate |
2021 |
| url |
https://doaj.org/article/46ce631ad6d047d7b0ad7e71ed0f6ee4 |
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