Complications and specific considerations in managing newly diagnosed DKA with COVID-19;Challenges in managing DKA with COVID-19 infection
Pediatric Diabetes
; 22(SUPPL 30):119, 2021.
Article
in English
| EMBASE | ID: covidwho-1571003
ABSTRACT
Introduction:
New cases of type 1 diabetes (T1D) remain commonly found in Indonesia. One of the most typical presenting symptoms is diabetic ketoacidosis (DKA);approximately 71% of all cases. There has been several reports of the negative association between type 2 diabetes (T2D) and Coronavirus disease (COVID-19) cases in adults, but T1D and COVID-19 cases in children are still scantily studied. Mortality of COVID-19 pediatric case could reach higher than 50% in children below 5 years old.Objectives:
Early detection and prompt treatment for DKA, T1D and COVID-19 should be emphasized.Methods:
This case described new-onset T1D presented with DKA and severe COVID-19 infection.Results:
7-year-old boy was presented with altered consciousness, epigastric pain, dehydration, dyspnea, history of nocturnal enuresis, polydipsia, and polyphagia. Random blood glucose (BG) was 516 mg/dL, blood ketone 5.2 mmol/L, A1c 15%, pH 6.932, pCO2 16 mmHg, pO2 153.8 mmHg, base excess-26.5 mmol/L, HCO3 3.4 mmol/L, and positive polymerase chain reaction COVID-19 with E gene Cq of 30.66. The patient was treated in isolation PICU as severe DKA with hypovolemic shock and confirmed COVID-19 case;received fluid resuscitation, intravenous insulin with saline and dextrose infusion and remdesivir. The patient had recurring hyponatremia, hyperkalemia, hypophosphatemia, increased coagulation markers, and had catecholamine-resistant shock, and received hydrocortisone from 2 mg/kg/day and subsequently titrated. The patient regained consciousness on the 2nd day of admission, and were stable on the 5th day of admission. The patient's condition improved on day 6 of admission and insulin and hydrocortisone were weaned. COVID-19 PCR test yielded negative result on day 9 of admission.Conclusions:
The COVID-19 pandemic presents additional unwanted complications in both clinical and non-clinical aspects of DKA and T1D management. Special considerations should be highlighted considering the comorbidities and medications given in addition to the treatment for DKA.
catecholamine; hydrocortisone; insulin; ketone; remdesivir; sodium, chloride; alkalosis; carbon, dioxide, tension; case, report; child; clinical, article; comorbidity; complication; conference, abstract; consciousness; coronavirus, disease, 2019; dehydration; diabetic, ketoacidosis; drug, dose, titration; drug, therapy; dyspnea; epigastric, pain; female; fluid, resuscitation; glucose, blood, level; glucose, infusion; human; hyperkalemia; hyperphagia; hyponatremia; hypophosphatemia; hypovolemic, shock; insulin, dependent, diabetes, mellitus; male; mortality; nocturnal, enuresis; null, result; pandemic; polydipsia; polymerase, chain, reaction; school, child
Full text:
Available
Collection:
Databases of international organizations
Database:
EMBASE
Language:
English
Journal:
Pediatric Diabetes
Year:
2021
Document Type:
Article
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