Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar State in Patients with COVID-19
Volume 3 ; Issue 2 ; in Month : July-Dec (2020) Article No : 119
Nasser Mikhail and Soma Wali
Background: It is unclear whether the 2 hyperglycemic emergencies, diabetic ketoacidosis (DKA), and hyperosmolar hyperglycemic state (HHS) have different characteristics in patients with COVID-19.
Objective: To describe prevalence, outcomes, and management of hyperglycemic crisis specifically in patients with COVID-19.
Methods: English literature search of electronic databases supplemented by manual search up to September 7, 2020. Search terms included hyperglycemic crises, diabetic ketoacidosis, COVID-19, ARDS, dexamethasone, mortality, safety. Since no randomized trials are available, all pertinent observational studies, case reports and major organization guidelines were reviewed.
Results: DKA occurs in 0.45 to 3.4% of patients with COVID-19 admitted to the hospital, and results in approximately 50% mortality rate. Excessive intravenous hydration should be avoided in patients at risk or having acute respiratory distress syndrome (ARDS) to avoid volume overload. In patients presenting with hyperglycemic crisis and COVID-19 requiring oxygen or on mechanical ventilation, dexamethasone may be given after resolution of hyperglycemic crisis. Insulin doses need to be increased by 50-100% to control dexamethasone-induced hyperglycemia. Selected patients with non-complicated both DKA and COVID-19 may be safely managed by subcutaneous rapid-acting insulin in a step-down unit with blood glucose monitoring every 2 hours. This strategy may spare beds in the intensive care unit (ICU) and personal protective equipment (PPE), and decrease nursing time at bedside.
Conclusions: Hyperglycemic crises with COVID-19 are uncommon but carry high mortality rate. Uncomplicated cases may be managed by step-down unit. Dexamethasone can be given after resolution of hyperglycemic crisis.
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