There is scarce data on diabetic ketoacidosis (DKA) in Covid-19 infection. We report a case of DKA precipitated by Covid-19 in a patient with newly diagnosed diabetes mellitus.
A 37 year-old, previously healthy man presented with 1 week history of fever, vomiting, polydipsia and polyuria.
On admission, his temperature was 38.5 o C. He was haemodynamically stable but mildly tachycardic. He did not display Kussmaul's breathing and did not require supplemental oxygen. His body mass index was 22.6 kg/m 2 with no evidence of insulin resistance.
Given positive contact history, he was tested and confirmed to be infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Laboratory investigations (Table 1) were significant for hyperglycemia, high anion gap metabolic acidosis and ketonemia, confirming the diagnosis of DKA. In addition, the relationship between SARS-CoV-2 and the RAAS can complicate DKA management. Excessive fluid resuscitation may potentiate acute respiratory distress syndrome as angiotensin II increases pulmonary vascular permeability and worsens damage to lung parenchyma 5 . Furthermore, angiotensin II stimulates aldosterone secretion, potentiating the risk of hypokalemia, which may necessitate more potassium supplementation in order to continue intravenous insulin to suppress ketogenesis.
In conclusion, it is possible that SARS-CoV-2 may aggravate pancreatic beta cell function and precipitate DKA. Further studies will help delineate the pathophysiology. We also highlight the pertinent clinical considerations in the concurrent management of two life-threatening conditions -DKA and Covid-19.
Funding: None.
Conflict of interest: None.