Diabetic Ketoacidosis Precipitated by COVID-19 infection: Case Series

Alsadhan, Ibrahim; Alruwashid, Shahad; Alhamad, Maram; Alajmi, Sarah; Alshehri, Sara; Alfadhli, Eman; Ekhzaimy, Aishah

BACKGROUND: Coronavirus has evolved into a devastating pandemic since December 2019. Saudi Arabia's first case was reported in March 2020. Subsequently, some 220,000 cases and 2,000 deaths were recorded through July 2020. COVID-19 infection aggravates glycemic control and provokes acute hyperglycemic crises, according to some reports. We made the same observations in some of our patients diagnosed with COVID-19. However, we are unaware of any reported cases of DKA among COVID-19 patients in Saudi Arabia. OBJECTIVE: Highlighting the significance of hyperglycemia on COVID-19 patient outcomes. METHODS: Five patients with DKA were admitted and diagnosed with COVID-19 based on real-time reverse transcription-polymerase chain reaction (RT-PCR) assays. Electronic medical records were reviewed and informed consent was obtained prior to reporting the index cases. RESULTS: Five patients presenting with DKA complicating a concurrent COVID-19 infection were reported. Three were known to have preexisting diabetes and two had newly diagnosed diabetes based on significantly elevated glycated hemoglobin levels at admission. Four recovered and were discharged to their homes and one had a complicated course and died. CONCLUSION: Our cases demonstrate that COVID-19 infection can trigger DKA. DKA can occur among patients who are known to have diabetes mellitus or appears as a first presentation. Clinicians should be extremely careful in checking for admission hyperglycemia and closely monitor respiratory status during fluid resuscitation of COVID-19-related DKA.