ABSTRACT
The finding that high-dose dexamethasone improves survival in those requiring critical care due to COVID-19 will mean much greater usage of glucocorticoids in the subsequent waves of coronavirus infection. Furthermore, the consistent finding of adverse outcomes from COVID-19 in individuals with obesity, hypertension and diabetes has focussed attention on the metabolic dysfunction that may arise with critical illness. The SARS coronavirus itself may promote relative insulin deficiency, ketogenesis and hyperglycaemia in susceptible individuals. In conjunction with prolonged critical care, these components will promote a catabolic state. Insulin infusion is the mainstay of therapy for treatment of hyperglycaemia in acute illness but what is the effect of insulin on the admixture of glucocorticoids and COVID-19? This article reviews the evidence for the effect of insulin on clinical outcomes and intermediary metabolism in critical illness.
Subject(s)
COVID-19 Drug Treatment , Glucocorticoids/adverse effects , Insulin/therapeutic use , Metabolic Diseases/chemically induced , Metabolic Diseases/prevention & control , COVID-19/complications , Critical Care/methods , Critical Illness/therapy , Dexamethasone/adverse effects , Dexamethasone/therapeutic use , Diabetes Complications/diagnosis , Diabetes Complications/drug therapy , Diabetes Complications/mortality , Diabetes Mellitus/drug therapy , Diabetes Mellitus/mortality , Diabetes Mellitus/virology , Glucocorticoids/therapeutic use , Humans , Hyperglycemia/complications , Hyperglycemia/drug therapy , Hyperglycemia/mortality , Metabolic Diseases/etiology , Obesity/complications , Obesity/drug therapy , Obesity/mortality , SARS-CoV-2/physiology , Treatment OutcomeABSTRACT
There is accumulating evidence to indicate an association between coronavirus infectious disease 2019 (COVID-19) and clusters of incident cutaneous eruptions. Of these, chilblains-like perniosis have received widespread medical and media attention. These typically affect the toes, and have been called "COVID-toes." Other acral lesions such as large bullae have also been reported. However, a definitive causal relationship with the severe acute respiratory syndrome coronavirus 2 has not yet been definitively proven, nor has a pathogenic mechanism been established. These episodes are self-limiting, but we need to know whether long-term sequelae exist.