Mohammad Ashraf Hasina, Sunderajan Trisha, Pierre Louisdon, Kondamudi Noah, Adeyinka Adebayo
Pediatrics, Children's Hospital Of Michigan, Detroit, USA.
Pediatrics, The Brooklyn Hospital Center, Brooklyn, USA.
Cureus. 2021 Dec 7;13(12):e20251. doi: 10.7759/cureus.20251. eCollection 2021 Dec.
Diabetic ketoacidosis (DKA) is a potentially life-threatening condition that occurs in patients with diabetes mellitus (DM) where the decrease in the insulin level leads to a state of metabolic acidosis and hyperglycemia. Based on the literature review, the risk of severity of DKA in children was significantly associated with coronavirus disease-2019 (COVID-19) cases during the first wave of the pandemic. This could be attributed to social distancing restrictions which delayed hospital presentation and timely treatment and interventions. We present the case of a 15-year-old female, with non-insulin-dependent diabetes (type 2), who presented during the COVID-19 pandemic with severe DKA from another hospital. She had elevated glucose level at home for three days that was worsening but her parents continue to manage the patient at home out of fear of the patient contracting COVID-19 if she was brought to the hospital. After she deteriorated, the parents took her to the nearest hospital which did not have a pediatric intensive care unit (PICU). She was immediately transferred to our facility. The patient was intubated immediately on arrival because of altered mental status possibly due to cerebral edema from severe metabolic acidosis and elevated glucose level. The patient rapidly progressed into shock, acute respiratory distress syndrome (ARDS), and multiple organ dysfunction syndrome (MODS). She was managed aggressively with vasopressors, fluid resuscitation, and insulin drip. She had four cardiac arrests for which she was resuscitated. Despite all efforts, she subsequently expired less than 24 hours after admission. We intend on shedding light on an emerging phenomenon due to the ongoing COVID-19 pandemic, wherein due to the fear of contracting COVID-19, many parents opt to keep and manage sick children at home. This report highlights the important role that the aversion of presenting to medical establishments out of fear of contracting COVID-19 may have led to the untimely and preventable death of our patient. It also outlines the importance of future educational reforms toward changing the patient and family's perception of hospitals and medical institutions, especially in children with pre-existing chronic medical conditions.
糖尿病酮症酸中毒（DKA）是一种可能危及生命的病症，发生于糖尿病（DM）患者中，胰岛素水平降低会导致代谢性酸中毒和高血糖状态。基于文献综述，在疫情第一波期间，儿童DKA严重程度的风险与2019冠状病毒病（COVID-19）病例显著相关。这可能归因于社交距离限制，其延迟了就医和及时的治疗及干预。我们报告一例15岁非胰岛素依赖型糖尿病（2型）女性病例，她在COVID-19大流行期间从另一家医院转来，患有严重DKA。她在家血糖升高三天且病情恶化，但她的父母因担心她去医院会感染COVID-19而继续在家中照料她。在她病情恶化后，父母将她送往最近一家没有儿科重症监护病房（PICU）的医院。她到达后因精神状态改变立即被插管，这可能是由于严重代谢性酸中毒和高血糖导致的脑水肿。患者迅速进展为休克、急性呼吸窘迫综合征（ARDS）和多器官功能障碍综合征（MODS）。对她进行了积极治疗，使用了血管活性药物、液体复苏和胰岛素滴注。她发生了四次心脏骤停并均被复苏。尽管全力抢救，她在入院后不到24小时死亡。我们旨在揭示由于持续的COVID-19大流行而出现的一种新现象，即由于担心感染COVID-19，许多父母选择将患病儿童留在家中照料。本报告强调了因害怕感染COVID-19而不愿前往医疗机构可能导致我们的患者 untimely且可预防的死亡这一重要作用。它还概述了未来教育改革对于改变患者和家庭对医院及医疗机构看法的重要性，特别是对于患有慢性基础疾病的儿童。
