Covid-19 pneumonia and diabetic ketoacidosis in a patient with type 2 diabetes

ABSTRACT

A 78-year- old man presented to the emergency department with acute confusion and urinary incontinence. His past medical history included type 2 diabetes with poor glycaemic control (HbA1c 126 mmol/mol Hb two months prior to admission). On examination he was febrile, tachycardic and clinically dehydrated. A chest x-ray confirmed right basal consolidation. Venous blood gas analysis showed an elevated glucose of 18.1 mmol/L and a raised anion gap metabolic acidosis. Capillary blood ketones were 6.1 mmol/L indicating diabetic ketoacidosis (DKA). Blood tests showed an acute kidney injury and markedly raised inflammatory markers (C-reactive protein 537 mg/L, WCC 11.6mg/l). A diagnosis of covid-19 pneumonia was made following detection of severe acute respiratory syndrome 2 (SARS CoV-2) on polymerase chain reaction (PCR) testing. The patient received treatment for DKA in accordance with the hospital's local clinical guidelines, which resolved rapidly within hours. His pneumonia was treated with intravenous ceftriaxone. The patient's clinical course in hospital was otherwise uncomplicated, but the case highlights the role of covid-19 as a possible precipitant of metabolic emergencies in patients with diabetes. There is increasing evidence describing the complex and multidirectional way in which covid-19 and diabetes interact. It is now well known that diabetes is one of the most important comorbidities associated with severe covid-19 disease. Recent research has suggested potential for the SARS CoV-2 virus itself to have a direct effect on beta cell function. This case illustrates the notion of diabetes being both a risk factor for and a condition that is worsened by covid-19.