SHM Converge Scientific Abstract ePoster Gallery-Sweet Surrender

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This case report describes a 74-year-old man who developed diabetic ketoacidosis (DKA) about one month after a mild COVID-19 infection. He presented to the emergency department with 20 days of worsening weakness, shortness of breath, nausea, vomiting, polyuria, polydipsia, and abdominal pain. His medical history included hypertension, hyperlipidemia, benign prostatic hyperplasia, peripheral arterial disease, and prior right nephrectomy for renal cell carcinoma. A screening HbA1c two years earlier had been 5.9%, suggesting prediabetes that he was unaware of.<br /><br />On exam, he appeared dehydrated with dry mucous membranes, decreased skin turgor, generalized weakness, and diffuse abdominal tenderness without guarding. Laboratory studies showed severe hyperglycemia (glucose 691 mg/dL), metabolic acidosis (bicarbonate 6), elevated white blood cell count (21.7 K/uL), hyperkalemia (K 5.9), elevated BUN/creatinine, and glucosuria. HbA1c was 10.4%, indicating previously unrecognized diabetes. C-peptide was low-normal at 1.03, and GAD65 antibody was negative. SARS-CoV-2 PCR remained positive. Imaging showed no acute chest process and incidental abdominal findings.<br /><br />He was treated with intravenous insulin and fluids for DKA. After the anion gap closed and blood glucose improved, he was transitioned to a basal-bolus insulin regimen. Once nausea and abdominal pain resolved, his diet was advanced. He was discharged home on basal insulin and oral hypoglycemic therapy, with diabetes education and close outpatient follow-up.<br /><br />The discussion emphasizes a bidirectional relationship between COVID-19 and diabetes. Proposed mechanisms include direct pancreatic beta-cell injury via ACE2 and TMPRSS2, cytokine-mediated stress hyperglycemia, and impaired insulin secretion. The report highlights the importance of monitoring high-risk patients after COVID-19 for new-onset diabetes and metabolic complications.

Asset Subtitle

FNU Ayesha

Meta Tag

Author List Ana Vilela, Chinenye Ezedike, FNU Ayesha, Nikita Mohan

Category Clinical Vignettes

Concept Diabetic Ketoacidosis

Concept Insulin Therapy

Concept Hyperglycemia

Concept Metabolic Acidosis

Concept Intravenous Fluids

Distinguished Non-Finalist

Presenter Organization Eastern Virginia Medical School, Norfolk

Presenting Author FNU Ayesha

Track Adult

Keywords

diabetic ketoacidosis

COVID-19

new-onset diabetes

hyperglycemia

HbA1c

insulin therapy

beta-cell injury

SARS-CoV-2

metabolic acidosis

case report

Diabetic Ketoacidosis

Insulin Therapy

Hyperglycemia

Metabolic Acidosis

Intravenous Fluids