126: Pediatric Patients Presenting With DKA With Incidental Finding of COVID-19 Infection

INTRODUCTION: Diabetic ketoacidosis (DKA) is an established complication of viral infections in patients with diabetes mellitus (DM) Adults with DM and with COVID 19 infections have been described to present to the hospital with DKA We describe the cases of two pediatric patients presenting with moderate to severe DKA in the context of otherwise asymptomatic or atypical COVID-19 infection METHODS: Both patients were 15 years old (one female and one male) and had a history of type 1 diabetes Despite elevated hemoglobin A1c (HbA1c), neither had been admitted with DKA since their initial diagnosis The female had recently traveled from an area with high community transmission rates for COVID-19 and presented with nausea, vomiting and decreased level of activity, but no fever or respiratory symptoms Laboratory evaluation showed an initial blood glucose of 600 mg/dL and venous pH of 6 7 Given her travel history, she was tested and was found to be COVID-19 positive The male presented with a one-day history of diffuse abdominal pain, emesis, sore throat, headache, and three day history of nonproductive cough and myalgias without fever His travel history shortly before presentation prompted COVID-19 testing, which was positive His initial evaluation showed a blood glucose of 515 mg/dL and venous pH of 7 17 Both patients were treated per institutional DKA protocol with an insulin infusion and two bag intravenous fluid rehydration therapy, transitioned to subcutaneous insulin and able to be discharged home by hospital day 2 RESULTS: Viral infections are frequent triggers for DKA in patients with new or established diabetes There are reported cases of influenza, and even arboviruses, preceding episodes of DKA and biologic plausibility exists for COVID-19 infection to cause DKA as well The acute and severe presentation of the female patient is also thought provoking There have been multiple case studies reporting DKA in adults with known diabetes with concomitant COVID-19 infections, but only a single case report in a pediatric patient These findings highlight the importance of COVID-19 testing in otherwise asymptomatic patients presenting in DKA, particularly if there is a history of exposure or elevated community transmission rates