Diabetic ketoacidosis precipitated by Coronavirus disease 2019 infection: Case series

Background: Coronavirus disease 2019 (COVID-19) has evolved into a devastating pandemic since December 2019. Saudi Arabia's first case was reported in March 2020. Subsequently, some 220,0 0 0 cases and 20 0 0 deaths were recorded through July 2020. COVID-19 infection aggravates glycemic control and provokes acute hyperglycemic crises, according to some reports. We made the same observations in some of our patients diagnosed with COVID-19. However, we are unaware of any reported cases of diabetic ketoacidosis (DKA) among COVID-19 patients in Saudi Arabia. Objective: Highlighting the significance of hyperglycemia on COVID-19 patient outcomes. Methods: Five patients with DKA were admitted and diagnosed with COVID-19 based on real-time reverse transcription-polymerase chain reaction assays. Electronic medical records were reviewed and informed consent was obtained before reporting the index cases. Results: Five patients presenting with DKA complicating a concurrent COVID-19 infection were reported. Three were known to have preexisting diabetes and 2 had newly diagnosed diabetes based on significantly elevated glycated hemoglobin levels at admission. Four recovered and were discharged to their homes and 1 had a complicated course and died. Conclusions: Our cases demonstrate that COVID-19 infection can trigger DKA. DKA can occur among patients who are known to have diabetes mellitus or appears as a first presentation. Clinicians should be extremely careful in checking for admission hyperglycemia and closely monitor respiratory status during fluid resuscitation of COVID-19-related DKA. (C) 2020 The Authors. Published by Elsevier Inc.