1 - Pediatric department, Hospital de São Francisco Xavier, Centro Hospitalar de Lisboa Ocidental, EPE
2 - Pediatric department, Centro Hospitalar Médio Tejo, EPE.
3 - Pediatric Endocrinology Unit, Hospital de Dona Estefânia, Centro Hospitalar e Universitário de Lisboa Central, EPE
- Congresso internacional online
- Apresentado sob forma de poster
Resumo:
Background: There has been a reduction in pediatric emergency department visits during the COVID-19 outbreak. Delayed search for medical help in children with symptoms of diabetes may have resulted in increased new-onset type 1 diabetes (T1D) presentations as diabetic ketoacidosis (DKA). It has been postulated that SARS-CoV-2 exposure could also have contributed, by precipitating or accelerating T1D.
Case Report: A teenage boy was brought to the emergency department with a two-month history of non-intentional 16% weight loss, polyphagia and polyuria. Fear of COVID-19 delayed the search for medical help. Few days before admission, he developed diarrhea, vomiting, fever, nasal congestion, anosmia and odynophagia. His mother and brother shared symptoms of anosmia and dysgeusia. On admission, he was malnourished, tachycardic and tachypneic, with clinical signs of dehydration. Laboratory evaluation confirmed new onset diabetes with diabetic ketoacidosis: hyperglycemia (517mg/dL); pH 7,18, bicarbonate 11,6mg/dL; positive anti-GAD (6,9 U/mL). On the following days, there was marked tendency to hyperglycemia, with daily insulin needs reaching 1,7 Units/Kg/day. Diabetes management was difficulted by his mother’s incorrect beliefs on diabetes management (she had poorly controlled Latent Autoimmune Diabetes of the Adult - LADA). Furthermore, episodes of anxiety and sadness required psychiatric support. COVID-19 diagnosis was confirmed by RT-PCR SARS-CoV-2 test, and respiratory symptoms were mild.
Discussion: In this case, the fear of COVID-19 delayed the search for medical help, which contributed to a severe disease presentation. This case also supports the role of SARS-CoV-2 as a possible accelerator of T1D, associated with increasing insulin doses.