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1.
Ann Med ; 53(1): 1642-1645, 2021 12.
Article in English | MEDLINE | ID: covidwho-1404914

ABSTRACT

OBJECTIVE: To compare patients with DKA, hyperglycaemic hyperosmolar syndrome (HHS), or mixed DKA-HHS and COVID-19 [COVID (+)] to COVID-19-negative (-) [COVID (-)] patients with DKA/HHS from a low-income, racially/ethnically diverse catchment area. METHODS: A cross-sectional study was conducted with patients admitted to an urban academic medical center between 1 March and 30 July 2020. Eligible patients met lab criteria for either DKA or HHS. Mixed DKA-HHS was defined as meeting all criteria for either DKA or HHS with at least 1 criterion for the other diagnosis. RESULTS: A total of 82 participants were stratified by COVID-19 status and type of hyperglycaemic crisis [26 COVID (+) and 56 COVID (-)]. A majority were either Black or Hispanic. Compared with COVID (-) patients, COVID (+) patients were older, more Hispanic and more likely to have type 2 diabetes (T2D, 73% vs 48%, p < .01). COVID(+) patients had a higher mean pH (7.25 ± 0.10 vs 7.16 ± 0.16, p < .01) and lower anion gap (18.7 ± 5.7 vs 22.7 ± 6.9, p = .01) than COVID (-) patients. COVID (+) patients were given less intravenous fluids in the first 24 h (2.8 ± 1.9 vs 4.2 ± 2.4 L, p = .01) and were more likely to receive glucocorticoids (95% vs. 11%, p < .01). COVID (+) patients may have taken longer to resolve their hyperglycaemic crisis (53.3 ± 64.8 vs 28.8 ± 27.5 h, p = .09) and may have experienced more hypoglycaemia <3.9 mmol/L (35% vs 19%, p = .09). COVID (+) patients had a higher length of hospital stay (LOS, 14.8 ± 14.9 vs 6.5 ± 6.0 days, p = .01) and in-hospital mortality (27% vs 7%, p = .02). DISCUSSION: Compared with COVID (-) patients, COVID (+) patients with DKA/HHS are more likely to have T2D. Despite less severe metabolic acidosis, COVID (+) patients may require more time to resolve the hyperglycaemic crisis and experience more hypoglycaemia while suffering greater LOS and risk of mortality. Larger studies are needed to examine whether differences in management between COVID (+) and (-) patients affect outcomes with DKA/HHS.


Subject(s)
COVID-19/complications , Diabetic Ketoacidosis/complications , Hyperglycemic Hyperosmolar Nonketotic Coma/complications , Acid-Base Equilibrium , Adult , Age Factors , Aged , COVID-19/blood , COVID-19/epidemiology , COVID-19/therapy , Comorbidity , Cross-Sectional Studies , Diabetes Mellitus, Type 2/epidemiology , Diabetic Ketoacidosis/blood , Female , Fluid Therapy , Glucocorticoids/therapeutic use , Humans , Hydrogen-Ion Concentration , Hyperglycemic Hyperosmolar Nonketotic Coma/blood , Length of Stay , Male , Middle Aged , SARS-CoV-2 , Safety-net Providers
2.
J Investig Med High Impact Case Rep ; 9: 23247096211021231, 2021.
Article in English | MEDLINE | ID: covidwho-1259169

ABSTRACT

We report 11 cases of combined diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar nonketotic coma (HHNK) in coronavirus 2019 patients who presented to our institution in New Jersey, USA. The median age was 47 years (range 12-88 years). Out of the 11 patients, 7 were male and 4 were female. Out of 11 patients, 8 had type 2 diabetes mellitus (DM), 2 had undiagnosed DM, and 1 had type 1 DM. Presenting complaints included altered mental status, weakness, shortness of breath, cough, fever, vomiting, abdominal pain, chest pain, and foot pain. Out of 11 patients, pneumonia was diagnosed at presentation in 8 patients, while in 3 patients, chest X-ray was clear. Median value of initial glucose on presentation was 974 mg/dL (range 549-1556 mg/dL), and hemoglobin A1c on presentation was 13.8%. The median value of anion gap was 34 mEq/L. Out of the 11 patients, ketonemia was moderate in 6 patients, large in 3, and small in 2 patients. Acute kidney injury (AKI) occurred in 9 patients and 2 patients required renal replacement therapy. Out of the 11 patients, 6 required mechanical ventilation and 7 patients died. All the 6 patients requiring mechanical ventilation died. Our case series shows COVID-19 infection can precipitate acute metabolic complications in known DM patients or as first manifestation in undiagnosed DM patients. Patients can present with DKA/HHNK symptoms and/or respiratory symptoms. Mechanical ventilation is a poor prognostic factor. Further studies are needed to characterize prognostic factors associated with mortality in this vulnerable patient population.


Subject(s)
COVID-19/complications , Diabetic Ketoacidosis/complications , Hyperglycemic Hyperosmolar Nonketotic Coma/complications , Acute Kidney Injury/etiology , Acute Kidney Injury/therapy , Adolescent , Adult , Aged , Aged, 80 and over , COVID-19/therapy , Child , Diabetes Mellitus, Type 1/complications , Diabetes Mellitus, Type 2/complications , Female , Humans , Male , Middle Aged , Renal Replacement Therapy , Respiration, Artificial , SARS-CoV-2 , Treatment Outcome , Young Adult
3.
Neurology ; 95(10): 454-457, 2020 09 08.
Article in English | MEDLINE | ID: covidwho-616669
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