Diabetic ketoacidosis precipitated by atypical coronavirus disease in a newly diagnosed diabetic girl

Abstract

Viral infections have a well-known influence on the pathophysiology of type 1 diabetes mellitus (T1DM). There is scant data about the impact of COVID-19 T1DM and diabetic ketoacidosis (DKA) on paediatric patients. This case presents a newly diagnosed paediatric patient with T1DM and DKA who was found to have SARS-CoV-2 without any respiratory symptoms. A 7-year-old girl presented with a history of polydipsia, polyuria, and weight loss. This presentation was complicated by a 2-day history of fatigue and vomiting. Investigations into the patient's condition confirmed T1DM with DKA. Following the infection control protocol, she underwent screening for SARS-CoV-2, which yielded a positive result. During her hospital stay, she did not develop fever or respiratory symptoms. The ketoacidosis was treated without any complications. We conclude that SARS-CoV-2 may trigger the onset of T1DM and may precipitate the occurrence of DKA in paediatric diabetic patients, even in the absence of respiratory symptoms.

Keywords: Coronavirus; Diabetes mellitus; Diabetic ketoacidosis; Paediatric; SARS Virus.

Figure 1

Patient's heart rate, urine output, and intravenous fluid rate trends for the first 24 h of admission. Explanation: The figure demonstrates the trends of three clinical parameters, namely heart rate, urine output, and the rate of intravenous fluid received by the patient during the first 24 h of admission at 3-hour intervals. The relatively low urine output for this diabetic patient may second the suggested interaction between the renin–angiotensin system (RAS) and the coronavirus.^, In addition, this may have prevented the occurrence of a severe degree of dehydration due to the water retention effect caused by the increased synthesis of aldosterone, which is reflected by her relatively stable heart rate.