Ketoacidosis in a diabetic patient associated with SARS-CoV-2 infection – Case report

Authors

DOI:

https://doi.org/10.33448/rsd-v11i6.29179

Keywords:

Diabetic Ketoacidosis; SARS-CoV-2; Diabetes Mellitus; Covid-19; Health teaching.

Abstract

Report of a patient with type 1 diabetes mellitus presenting with severe diabetic ketoacidosis associate with SARS-CoV-2 infection under treatment in an Intensive Care Unit at a Hospital in the city of Manaus-AM. A 50-year-old male patient with previous diagnosis of Psoriasis Vulgaris and Type 1 Diabetes Mellitus, in regular use of Insulin, presented a flu-like syndrome manifested by fever, dyspnea, myalgia and anosmia. After five days evolved with worsening of breathing pattern associated with a decline in general condition. Subsequently diagnosed with Severe Ketoacidosis associated with SARS-CoV-2 infection, then admitted to an Intensive Care Unit bed, being discharged after 08 days of hospitalization with substantial improvement in the respiratory condition and resolution of ketoacidosis. The relationship between SARS-CoV-2 infection and the development of ketoacidosis in diabetic patients became clear, as well as the association between ICU care and better outcome.

References

Chan, K. H., Thimmareddygari, D., Ramahi, A., Atallah, L., Baranetsky, N. G., & Slim, J. (2020). Clinical characteristics and outcome in patients with combined diabetic ketoacidosis and hyperosmolar hyperglycemic state associated with COVID-19: A retrospective, hospital-based observational case series. Diabetes Research and Clinical Practice, 166. https://doi.org/10.1016/j.diabres.2020.108279

Chee, Y. J., Ng, S., & Yeoh, E. (2020). Diabetic ketoacidosis precipitated by Covid-19 in a patient with newly diagnosed diabetes mellitus. Diabetes research and clinical practice, 164, 108166. https://doi.org/10.1016/j.diabres.2020.108166

Goldman, N., Fink, D., Cai, J., Lee, Y. N., & Davies, Z. (2020). High prevalence of COVID-19-associated diabetic ketoacidosis in UK secondary care. Diabetes Research and Clinical Practice, 166. https://doi.org/10.1016/j.diabres.2020.108291

Hoffmann, M., Kleine-Weber, H., Schroeder, S., Krüger, N., Herrler, T., Erichsen, S., Schiergens, T. S., Herrler, G., Wu, N. H., Nitsche, A., Müller, M. A., Drosten, C., & Pöhlmann, S. (2020). SARS-CoV-2 Cell Entry Depends on ACE2 and TMPRSS2 and Is Blocked by a Clinically Proven Protease Inhibitor. Cell, 181(2), 271–280.e8. https://doi.org/10.1016/j.cell.2020.02.052

Huang, I., Lim, M. A., & Pranata R. (2020). Diabetes mellitus is associated with increased mortality and severity of disease in COVID-19 pneumonia – a systematic review, meta-analysis, and meta-regression. Diabetes Metab Syndr, 14:395–403.

IDF - International Diabetes Federation. (2019). IDF Diabetes Atlas. 9. ed. Brussels (BEL).

Kitabchi, A. E., Umpierrez, G. E., Miles, J. M., & Fisher, J. N. (2009). Hyperglycemic crises in adult patients with diabetes. Diabetes care, 32(7), 1335–1343. https://doi.org/10.2337/dc09-9032

Li, J., Wang, X., Chen, J., Zuo, X., Zhang, H., & Deng, A. (2020). COVID-19 infection may cause ketosis and ketoacidosis. Diabetes, obesity & metabolism, 22(10), 1935–1941. https://doi.org/10.1111/dom.14057

Mauvais-Jarvis, F., Sobngwi, E., Porcher, R., Riveline, J. P., Kevorkian, J. P., Vaisse, C., Charpentier, G., Guillausseau, P. J., Vexiau, P., & Gautier, J. F. (2004). Ketosis-prone type 2 diabetes in patients of sub-Saharan African origin: clinical pathophysiology and natural history of beta-cell dysfunction and insulin resistance. Diabetes, 53(3), 645–653. https://doi.org/10.2337/diabetes.53.3.645

Nyenwe, E. A., & Kitabchi, A. E. (2016). The evolution of diabetic ketoacidosis: na update of its etiology, pathogenesis and management. Metabolism; 65(4):507-521.

Orioli, L., Hermans, M. P., Thissen, J. P., Maiter, D., Vandeleene, B., & Yombi, J. C. (2020). COVID-19 in diabetic patients: Related risks and specifics of management. Annales d'endocrinologie, 81(2-3), 101–109. https://doi.org/10.1016/j.ando.2020.05.001

Oyarzabal, I. M., García, C. B., Barrio, C. R., Torres, L. M., Gómez, G. A. L., González, C. I., Hermoso, L. F., Luzuriaga, T. C., Rica, E. I., López, G. M. J., & Rodríguez, R. M. (2012). Ketoacidosis at onset of type 1 diabetes mellitus in pediatric age in Spain and review of the literature. Pediatric endocrinology reviews: PER, 9(3), 669–671.

Pititto, B. A., & Ferreira, S. R. G. (2020). Diabetes and covid-19: more than the sum of two morbidities. Revista de Saúde Pública, v. 54 https://doi.org/10.11606/s1518-8787.2020054002577

Palermo, N. E., Sadhu, A. R., & McDonnell, M. E. (2020). Diabetic Ketoacidosis in COVID-19: Unique Concerns and Considerations. The Journal of clinical endocrinology and metabolism, 105(8), dgaa360. https://doi.org/10.1210/clinem/dgaa360

Santos, W. L., Laranjeira, D. B., Ribeiro, K. L., Cruz, K. O., Silva, S. S., Pacheco, E. V. F., & Oliveira Filho, W. (2022). SARS-CoV-2 infection in an insulin-dependent type I diabetic patient with subsequent ketoacidosis – Case Report. Research, Society and Development, 11(5), e32211528342. https://doi.org/10.33448/rsd-v11i5.28342

Tan, H., Wang, C., & Yu, Y. (2012). H1N1 influenza: the trigger of diabetic ketoacidosis in a young woman with ketosis-prone diabetes. Am J Med Sci.; 343(2):180-183.

Tay, M. Z., Poh, C. M., Rénia, L., MacAry, P. A., & Ng, L. F. P. (2020). The trinity of COVID-19: immunity, inflammation and intervention. Nat Rev Immunol; 20:363–74. http://dx.doi.org/10.1038/s41577-020-0311-8.

Wyckoff, J., & Abrahamson, M. J. (2005). Diabetic ketoacidosis and hyperosmolar hyperglycemic state. ln: Joslin's Diabetes Mellitus, 14th ed., Philadelphia: Lippin cott Williams and Wilkins, p. 887-99.

World Health Organization. (2020). Naming the coronavirus disease (COVID-19) and the virus that causes it 2020 [31/03/2020]. Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/naming-the-coronavirus-disease-(covid-2019)-and-the-virus-that-causes-it.

Zhou, J., & Tan J. (2020). Diabetes patients with COVID-19 need better blood glucose management in Wuhan, China. Metabolism. 107:154216. doi:10.1016/j.metabol.2020.154216.

Zhu, N., Zhang, D., Wang, W., Li, X., Yang, B., Song, J., Zhao, M., Huang, B., Shi, W., Lu, R., Niu, P., Zhan, F., Ma, X., Wang, D., Xu, W., Wu, G., Gao, G. F., & Tan, W. (2020). A novel coronavirus from patients with pneumonia in China, 2019. The New England Journal of Medicine, 382:727-33. http://doi.org/10.1056/NEJMoa2001017

Published

30/04/2022

How to Cite

RIBEIRO, K. L. .; LARANJEIRA, D. B. .; SANTOS, W. L. dos .; SILVA, S. S. da .; CRUZ, K. de O. .; PACHECO, E. V. F. .; OLIVEIRA FILHO, W. de. Ketoacidosis in a diabetic patient associated with SARS-CoV-2 infection – Case report. Research, Society and Development, [S. l.], v. 11, n. 6, p. e35311629179, 2022. DOI: 10.33448/rsd-v11i6.29179. Disponível em: https://rsdjournal.org/index.php/rsd/article/view/29179. Acesso em: 28 may. 2022.

Issue

Section

Health Sciences