Severe Hyperglycaemia with Concomitant Asymptomatic Covid-19 Infection: A Case Report Severe Hyperglycaemia with Concominant Covid-19

Backgroud: Acute hyperglycaemic crises, such as diabetic ketoacidosis (DKA) and hyperosmolar hyperglycaemic state (HHS), are serious and potentially life-threatening complications of diabetes that can also be triggered by viral infections. Case Report: A 64-year-old woman was admitted to the hospital emergency department because of syncope and impaired consciousness that began the previous day. The patient had experienced polydipsia, polyuria, and weight loss over the past four weeks. Laboratory results revealed a serum glucose concentration of 2362.2 mg/dL. A positive RT-PCR test for SARS-CoV-2 was also document- ed. Finally, the patient was diagnosed with hyperglycaemic-hyperosmolar syndrome (HHS), hypo- kalaemia and nonketotic metabolic acidosis. Hyperglycaemia was treated with an insulin bolus, followed by continuous infusion under glucose monitoring. The patient received also multi-elec- trolyte solution therapy. Conclusion: COVID-19 infection may significantly influence blood glucose levels. During the diag- nostic evaluation and treatment of hyperglyceridaemia, clinicians should remain vigilant for the potential diagnosis of DKA and/or HHS. 1. Li J, Wang X, Chen J, Zuo X, Zhang H, Deng A. COVID-19 infection may cause ketosis and ketoacidosis. Diabetes Obes Metab 2020;22:1935–1941. 2. Naranjo JMA, Larrondo EFH, Arroyo MGS. Combined diabetic ketoacidosis and hyperosmolar hyperglycemic state associated with COVID 19. J Endocr Soc 2021;5:A372-A373.6 3. Pasquel FJ, Tsegka K, Wang H, Cardona S, Galindo RJ, Fayfman M, et al. Clinical outcomes in patients with isolated or combined diabetic ketoacidosis and hyperosmolar hyperglycemic state: A retrospective, hospital-based cohort study. Diabetes Care 2019;43:349-357.7 4. Pal R, Banerjee M, Yadav U, Bhattacharjee S. Clinical profile and outcomes in COVID-19 patients with diabetic ketoacidosis: A systematic review of literature. Diabetes Metab Syndr Clin Res Rev 2020;14:1563-1569.1 5. Hasan SS, Kow CS, Bain A, Kavanagh S, Merchant HA, Hadi MA. Pharmacotherapeutic considerations for the management of diabetes mellitus among hospitalized COVID-19 patients. Expert Opin Pharmacother 2021;22:229-240.2 6. Papadopoulos VP, Koutroulos MV, Zikoudi DG, Bakola SA, Avramidou P, Touzlatzi N, Filippou DK. Acute metabolic emergencies in diabetes and COVID-19: a systematic review and meta-analysis of case reports. Diabetol Int 2021;12:445-459.3 7. Kim N, Ha E, Moon JS, Lee YH, Choi EY. Acute hyperglycemic crises with coronavirus disease-19: Case reports. Diabetes Metab J 2020;44:349-353.4 8. Umpierrez GE. Hyperglycemic crises: Diabetic ketoacidosis and hyperglycemic hyperosmolar state. In: Bonora E, DeFronzo RA, editors. Diabetes complications, comorbidities and related disorders. Endocrinology. Cham: Springer International Publishing; 2020. p.595-614.5 9. Bhattaram S, Shinde VS, Khumujam PP, Anilkumar AP, Reddy DK. Capnography as a tool for triaging and diagnosis of diabetic ketoacidosis in the emergency department: A prospective observational study. Turk J Emerg Med 2023;23:169-175.8 10. Fayfman M, Pasquel FJ, Umpierrez GE. Management of hyperglycemic crises: Diabetic ketoacidosis and hyperglycemic hyperosmolar state. Med Clin North Am 2017;101:587-606.9