Severe COVID pneumonia complicated with transient Diabetic ketoacidosis in a diabetes-naive patient: A case report and literature review

A very few cases with Coronavirus disease (COVID-19) inducing Diabetic ketoacidosis in non-diabetic patients are reported. Hyperglycaemia caused by transient damage to pancreatic cells by the virus and cytokine storm is identified as the underlying pathophysiology. Here, we present a patient who presented with transient Diabetic ketoacidosis while being treated for COVID-19 pneumonia and is the first reported case in Sri Lanka as per literature. We highlight the approach to diagnosis, monitoring and management of this patient which was challenging for the treating physician. Case: A 34-year-old previously well Sri Lankan male presented with severe covid pneumonia. He was found to have diabetic ketoacidosis and managed as per protocol with fluid and insulin. His glycosylated haemoglobin was normal. Even though his Covid pneumonia worsened leading to death, he recovered from diabetic ketoacidosis and did not require exogenous insulin later in the course of the illness. Conclusion: Transient hyperglycemia with ketoacidosis, such as in our patient, associated with Covid infection has been reported very rarely in the literature. The treating physician should have a high index of suspicion to diagnose these types of patients and to manage them timely. Otherwise, it will be an added but a preventable factor to increase mortality in patients with Covid pneumonia.