Diabetic Ketoacidosis in COVID-19: Unique Concerns and Considerations
Diabetic Ketoacidosis in COVID-19: Unique Concerns and Considerations
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DOI：
10.1210/clinem/dgaa360
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发表时间：
2020-08-01
影响因子：
5.8
通讯作者：
McDonnell, Marie E.
中科院分区：
文献类型：
--
作者：
Palermo, Nadine E.;Sadhu, Archana R.;McDonnell, Marie E.
内容：虽然糖尿病患者感染SARS-CoV-2的风险似乎与非糖尿病患者相似，但他们更有可能遭受严重后果，包括死亡。糖尿病酮症酸中毒（DKA）是一种常见的和潜在致命的急性并发症的糖尿病引起的相对胰岛素缺乏，这更常见于那些与1型糖尿病和在中度至重度疾病的设置。早期的报告表明，在已有糖尿病的患者中，DKA可能是严重COVID-19的常见并发症，并且是预后不良的体征。病例描述：本临床观点通过2个病例探讨了在COVID-19大流行期间护理DKA患者的关键要素。讨论的主题包括诊断、分诊和治疗的基本原则，重点是描述DKA严重程度和医疗复杂性的重要性，以确定最佳方法。结论：如上所述，由于重要的公共卫生目标，DKA管理的一些原则可能需要在COVID-19的设置中具有灵活性，例如防止传播给最高风险个体，减少医护人员与受感染病人的接触，保护个人防护设备。探索替代治疗策略的证据，特别关注在大流行期间可能更相关的治疗选择，包括使用皮下胰岛素治疗。最后，DKA通常是一种可预防的疾病。我们包括基于证据的策略和指导，旨在使临床医生和患者尽可能避免这种严重的并发症。
Context: While individuals with diabetes appear to be at similar risk for SARS-CoV-2 infection to those without diabetes, they are more likely to suffer severe consequences, including death. Diabetic ketoacidosis (DKA) is a common and potentially lethal acute complication of diabetes arising from a relative insulin deficiency, which occurs more often in those with type 1 diabetes and in the setting of moderate to severe illness. Early reports indicate that among patients with pre-existing diabetes, DKA may be a common complication of severe COVID-19 and a poor prognostic sign.Case Description: This clinical perspective explores the key elements of caring for individuals with DKA during the COVID-19 pandemic through 2 cases. Topics addressed include diagnosis, triage, and the fundamental principles of treatment with a focus on the importance of characterizing DKA severity and medical complexity to determine the best approach.Conclusions: As discussed, some tenets of DKA management may require flexibility in the setting of COVID-19 due to important public health goals, such as preventing transmission to highest risk individuals, reducing healthcare worker exposure to infected patients, and preserving personal protective equipment. Evidence for alternative treatment strategies is explored, with special attention placed on treatment options that may be more relevant during the pandemic, including use of subcutaneous insulin therapy. Finally, DKA is often a preventable condition. We include evidence-based strategies and guidance designed to empower clinicians and patients to avoid this serious complication when possible.