Diabetic Ketoacidosis Precipitated by COVID-19 in Patients Without Respiratory Symptoms: Case Reports

Worse outcomes of coronavirus disease 2019 (COVID-19) have been documented in older patients with comorbidities, especially in those with diabetes mellitus (DM) However, the clinical picture and risk factors of COVID-19 in DM is still emerging Here, we report four cases of severe COVID-19 patients with acute diabetic ketoacidosis (DKA) without respiratory symptoms, with viral and bacterial coinfection, and poor clinical outcomes Higher monitoring of patients with DM and COVID- 19 is advised, as well as rapid and accurate diagnostic tests and treatment