Endocrine Abstracts

Introduction

Diabetes mellitus (DM) is one of the risk factors associated with severe illness in Coronavirus disease 2019 (COVID-19) leading to increased hospital admissions and mortality. COVID-19 can precipitate hyperglycemic emergencies like diabetic ketoacidosis (DKA) in patients with DM. We report 2 cases of diabetic ketoacidosis (DKA) secondary to COVID-19 with an atypical clinical picture mainly made up of neurological disorders without respiratory signs.

Observations

Case 1: A 67-year-old patient, Type 1 diabetic for 34 years, is admitted for DKA. The symptoms go back 10 days made of asthenia and disorders of consciousness without respiratory signs. On admission the patient was drowsy and afebrile. Hemoglobin A1c was 11%. There was lymphopenia, mild cytolysis, and increased c-reactive protein (CRP). The chest x-ray showed an interstitial syndrome with no obvious pulmonary opacity. The lumbar puncture was normal as well as the cerebral CT scan. In view of the absence of evident factor that precipitated DKA, we performed a SARS-CoV-2 RT-PCR test which had returned positive. The patient was transferred to the COVID unit. The course was marked by repetitive episodes of hypoglycemia with significant reduction in daily insulin doses. The patient improved with PCR negative after 12 days. Case 2: A 57-year-old patient, type 2 diabetic for 23 years on oral antidiabetics, is admitted for DKA. Symptoms can be traced back to a week marked by the onset of asthenia and vomiting without coughing or dyspnea. On admission the patient was subfebrile and drowsy. He even fell from his bed because of the neurological disorders. He had lymphopenia, mild hepatic cytolysis and a slight increase in CRP. On the chest x-ray there was an alveolar-interstitial syndrome. The respiratory condition worsened on the 3rd day of his hospitalization requiring the use of Oxygen therapy. SARS-CoV-2 RT-PCR test returned positive and the patient was transferred to the COVID unit with good evolution after 10 days.

Conclusion

These case reports highlight important issues in DM patients with DKA. First, we documented the variability of the clinical picture of COVID-19. We have recognized patients without respiratory symptoms, with severe metabolic complication. Second, SARS-CoV-2 must be considered as a cause of metabolic decompensation even in patients without respiratory symptoms. In this regard, adequate use of personal protective equipment should be considered in the attention of these patients until SARS-CoV-2 is ruled out.