289 results match your criteria presenting dka


Temporal trends in emergency admissions for diabetic ketoacidosis in people with diabetes in England before and during the COVID-19 pandemic: a population-based study.

Lancet Diabetes Endocrinol 2021 10 2;9(10):671-680. Epub 2021 Sep 2.

National Diabetes Audit Programme, NHS England and NHS Improvement, London, UK; Division of Metabolism, Digestion, and Reproduction, Imperial College London, London, UK; Department of Diabetes and Endocrinology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK; NHS England and NHS Improvement, London UK. Electronic address:

Background: Diabetic ketoacidosis (DKA) has been reported to be increasing in frequency during the COVID-19 pandemic. We aimed to examine the rates of DKA hospital admissions and the patient demographics associated with DKA during the pandemic compared with in prepandemic years.

Methods: Using a comprehensive, multiethnic, national dataset, the Secondary Uses Service repository, we extracted all emergency hospital admissions in England coded with DKA from March 1 to June 30, 2020 (first wave of the pandemic), July 1 to Oct 31, 2020 (post-first wave), and Nov 1, 2020, to Feb 28, 2021 (second wave), and compared these with DKA admissions in the equivalent periods in 2017-20. Read More

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October 2021

Evaluation of Characteristics and Outcomes for Patients with Diabetic Ketoacidosis (DKA) With and Without COVID-19 in Elmhurst Queens During Similar Three-Month Periods in 2019 and 2020.

Cureus 2021 Jul 16;13(7):e16427. Epub 2021 Jul 16.

Endocrinology, Icahn School of Medicine Mount Sinai / NYC Health + Hospitals/Elmhurst, New York City, USA.

Aim There are reports of COVID-19 patients presenting with new onset diabetes, diabetic ketoacidosis (DKA), and hyperosmolar hyperglycemic syndrome (HHS). We compared the characteristics of patients with DKA with and without COVID-19 and their effect on mortality. Research design and methods A retrospective study at Elmhurst Hospital Center in Queens, New York was performed using ICD-10 codes to identify patients with DKA from March 1 to May 31 in 2019 and 2020. Read More

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The Impact of COVID-19 Pandemic on Prevalence of Diabetic Ketoacidosis at Diagnosis of Type 1 Diabetes: A Single-Centre Study in Central Pennsylvania.

Endocrinol Diabetes Metab 2021 07 17;4(3):e00235. Epub 2021 Feb 17.

Division of Pediatric Diabetes and Endocrinology Penn State Hershey Medical Center Hershey PA USA.

Objective: We conducted this study to investigate whether the COVID-19 pandemic impacted the rate of DKA and previously identified risk factors in children presenting with T1D.

Methods: We performed an extension of a retrospective analysis of all paediatric patients (age ≤ 18) newly diagnosed with T1D within a tertiary care referral centre between 01/01/2017 and 09/14/2020. Demographics, insurance coverage and clinical documents 30 days before their T1D diagnosis were abstracted to assess for symptoms at diagnosis, laboratory values (blood glucose, HbA, venous pH and bicarbonate) and any healthcare encounters within 30 days of their diagnosis of T1D. Read More

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The SARS-CoV-2 pandemic is associated with increased severity of presentation of childhood onset type 1 diabetes mellitus: A multi-centre study of the first COVID-19 wave.

Diabet Med 2021 09 18;38(9):e14640. Epub 2021 Jul 18.

Department of Paediatric Endocrinology and Diabetes, Great Ormond Street Hospital, London, UK.

Objective: Children are usually mildly affected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19). However, the pandemic has caused collateral damage to those with non-COVID-19 diseases. We aimed to determine the impact of the COVID-19 pandemic on the presentation of newly diagnosed childhood onset type 1 diabetes. Read More

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September 2021

Acute respiratory distress syndrome in a case of diabetic ketoacidosis requiring ECMO support.

Endocrinol Diabetes Metab Case Rep 2021 Jul 1;2021. Epub 2021 Jul 1.

Department of Endocrinology and Diabetes, Beaumont Hospital, Dublin, Ireland.

Summary: Acute respiratory distress syndrome (ARDS) is a rare but life-threatening complication of diabetic ketoacidosis (DKA). We present the case of a young female, with no previous diagnosis of diabetes, presenting in DKA complicated by ARDS requiring extra corporeal membrane oxygenation (ECMO) ventilator support. This case report highlights the importance of early recognition of respiratory complications of severe DKA and their appropriate management. Read More

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Presentation of newly diagnosed type 1 diabetes in children and young people during COVID-19: a national UK survey.

BMJ Paediatr Open 2020 2;4(1):e000884. Epub 2020 Nov 2.

Department of Paediatrics, Nottingham University Hospitals NHS Trust, Nottingham, UK.

In the UK, there have been reports of significant reductions in paediatric emergency attendances and visits to the general practitioners due to COVID-19. A national survey undertaken by the UK Association of Children's Diabetes Clinicians found that the proportion of new-onset type 1 diabetes (T1D) presenting with diabetes ketoacidosis (DKA) during this COVID-19 pandemic was higher than previously reported, and there has been an increase in presentation of severe DKA at diagnosis in children and young people under the age of 18 years. Delayed presentations of T1D have been documented in up 20% of units with reasons for delayed presentation ranging from fear of contracting COVID-19 to an inability to contact or access a medical provider for timely evaluation. Read More

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November 2020

Brugada Pattern Phenocopy Induced by Diabetic Ketoacidosis.

Cureus 2021 May 16;13(5):e15066. Epub 2021 May 16.

Interventional Cardiology, Unity Health, Searcy, USA.

Brugada syndrome is a congenital cardiac channelopathy characterized by ST-segment elevation (≥2 mm) and subsequent inverted T wave in a minimum of two right precordial leads (Brugada type 1 ECG [electrocardiogram] pattern) on ECG. Brugada syndrome is estimated to be responsible for 4%-12% of all sudden cardiac deaths and up to 20% in patients with structurally normal hearts. Development of a temporary Brugada pattern, known as Brugada phenocopy, has been observed in individuals presenting with reversible underlying conditions such as hyperkalemia, hyponatremia, acidosis, ischemia, and pulmonary embolism, among others. Read More

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Diabetic ketoacidosis at presentation of type 1 diabetes in children in Canada during the COVID-19 pandemic.

Paediatr Child Health 2021 Jul 8;26(4):208-209. Epub 2021 Apr 8.

Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada.

Type 1 diabetes is a common chronic illness in childhood. Diabetic ketoacidosis (DKA) is the leading cause of morbidity and mortality in children with type 1 diabetes. Early recognition of symptoms of diabetes and immediate initiation of treatment are important factors in preventing DKA at first presentation. Read More

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A rare case of diabetic ketoacidosis presenting with severe hypertriglyceridemia requiring plasmapheresis in an adult with type-2 diabetes mellitus: Case report.

Medicine (Baltimore) 2021 Jun;100(23):e26237

Internal Medicine Residency Program, UPMC Pinnacle Harrisburg Hospital.

Introduction: Severe hypertriglyceridemia (HTG) is a rare complication of insulin resistance. Its presentation with diabetic ketoacidosis (DKA) has been reported in a few cases, where most patients have type-1 diabetes mellitus (DM). Our case represents a unique presentation of DKA associated with severe HTG above 10,000 mg/dL in an adult with type-2 DM. Read More

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Performance of the APACHE II and SOFA Scores in Diabetic Ketoacidosis.

J Intensive Care Med 2021 Jun 11:8850666211023718. Epub 2021 Jun 11.

Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.

Accurate prediction of severity and mortality in diabetic ketoacidosis (DKA) is important for allocation of resources. The APACHE II and SOFA scores are used to predict mortality in critically ill patients, however neither has been tested exclusively in DKA. We sought to determine if these scoring systems can accurately predict mortality in patients with DKA. Read More

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Variability in Emergency Management of Pediatric Diabetic Ketoacidosis.

Can J Diabetes 2021 Mar 16. Epub 2021 Mar 16.

Department of Pediatrics, Queen's University, Kingston, Ontario, Canada.

Objectives: Our aim in this study was to identify pediatric patients presenting in diabetic ketoacidosis (DKA) who received initial treatment inconsistent with current guidelines, and then to track associated complications.

Methods: This retrospective chart review examined 47 pediatric patients admitted to our institution with DKA, including those transferred from community hospitals. Primary outcome measures were exposure to treatment-related risk factors for cerebral edema (CE), including administration of an intravenous (IV) insulin bolus, IV bicarbonate, insulin within 1 hour of IV fluid start and non-NPO (nil per os) status. Read More

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Methamphetamine use and the risk of diabetic ketoacidosis.

Med Sci Law 2021 Jun 9:258024211020936. Epub 2021 Jun 9.

Adelaide Medical School, The University of Adelaide, Australia.

Diabetic ketoacidosis (DKA) is a life-threatening condition arising in individuals with insulin-dependent diabetes mellitus, associated with hyperglycaemia and hyperketonaemia. While drugs such as methadone, cocaine and certain prescription medications may precipitate DKA, the potential effect of methamphetamine is unclear. Analysis of autopsy and toxicology case files at Forensic Science SA, Adelaide, South Australia, was therefore undertaken from 1 January to 31 December 2019 of all cases where methamphetamine was detected in post-mortem blood samples. Read More

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Searching for the Culprit: When Diabetic Ketoacidosis Presents With Insulin Autoantibodies.

AACE Clin Case Rep 2021 Mar-Apr;7(2):158-162. Epub 2020 Dec 28.

Department of Medicine, St. Joseph's University Medical Center, Paterson, New Jersey.

Objective: The main objective was to describe and review a unique case that presented with diabetic ketoacidosis, positive insulin autoantibodies (IAAbs, which are found in Hirata disease and are usually present with hypoglycemia), and laboratory findings characteristic of type B insulin resistance syndrome (TBIRS) and systemic lupus erythematosus. Confirmation of TBIRS was obtained in Germany as immunoassay for insulin receptor antibodies (IRAbs) is not available in the United States.

Methods: A literature review on TBIRS and cases that present with IAAbs and IRAbs simultaneously was conducted. Read More

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December 2020

COVID-19 and Combined Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar Nonketotic Coma: Report of 11 Cases.

J Investig Med High Impact Case Rep 2021 Jan-Dec;9:23247096211021231

Saint Joseph's University Medical Center, Paterson, NJ, USA.

We report 11 cases of combined diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar nonketotic coma (HHNK) in coronavirus 2019 patients who presented to our institution in New Jersey, USA. The median age was 47 years (range 12-88 years). Out of the 11 patients, 7 were male and 4 were female. Read More

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Hyperlactatemia associated with diabetic ketoacidosis in pediatric intensive care unit.

BMC Endocr Disord 2021 May 27;21(1):110. Epub 2021 May 27.

Department of Pediatric Intensive Care Unit, The First Hospital of Jilin University, Xin Min Street, 130021, Changchun, China.

Background: Children with diabetic ketoacidosis often have elevated lactate. In this study, we investigated the clinical variables associated with hyperlactatemia in children with diabetic ketoacidosis.

Methods: We designed a single-center retrospective descriptive study of children with diabetic ketoacidosis in a pediatric intensive care unit. Read More

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Hypertriglyceridemia with acute pancreatitis in a 14-year-old girl with diabetic ketoacidosis.

Ann Pediatr Endocrinol Metab 2021 May 14. Epub 2021 May 14.

Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Diabetic ketoacidosis (DKA) is a medically fatal condition in poorly controlled hyperglycemia or newly diagnosed diabetes mellitus. Severe hypertriglyceridemia (HTG) is an uncommon complication of DKA and can be associated with acute pancreatitis (AP). We present the clinical manifestations, laboratory findings, and management of AP associated with HTG in a 14-year-old girl with DKA. Read More

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10-Year Incidence of Diabetic Ketoacidosis at Type 1 Diabetes Diagnosis in Children Aged Less Than 16 Years From a Large Regional Center (Hangzhou, China).

Front Endocrinol (Lausanne) 2021 27;12:653519. Epub 2021 Apr 27.

Department of Endocrinology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China.

Background: Diabetic ketoacidosis (DKA) is a potentially life-threatening complication of type 1 diabetes (T1D), and a leading cause of death in children aged <15 years with new-onset T1D.

Aims: i) to assess the incidence of DKA in children and adolescents newly diagnosed with T1D over a 10-year period at a large regional center in China; and ii) to examine the clinical symptoms and demographic factors associated with DKA and its severity at diagnosis.

Methods: We carried out a retrospective audit of a regional center, encompassing all youth aged <16 years diagnosed with T1D in 2009-2018 at the Children's Hospital, Zhejiang University School of Medicine (Hangzhou, China). Read More

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Fluid and electrolyte therapy in childhood diabetic ketoacidosis management: A rationale for new national guideline.

Diabet Med 2021 Aug 17;38(8):e14595. Epub 2021 May 17.

Paediatric Department, Southport and Ormskirk NHS Trust, Ormskirk, UK.

Fluid and electrolyte therapy in childhood diabetic ketoacidosis (DKA) management has been controversial. Previous National Institute for Health and Care Excellence (NICE) 2015 guidance advocated a restricted fluid regimen while more recent guidelines have advocated a more liberal approach to fluid replacement in DKA. At the core of the debate is the need to avoid developing cerebral oedema as a complication. Read More

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Status epilepticus and diabetes ketoacidosis: uncommon clinical presentations of acromegaly.

Endocrinol Diabetes Metab Case Rep 2021 Apr 1;2021. Epub 2021 Apr 1.

Department of Internal Medicine, Kilimanjaro Christian Medical Centre, Moshi, Tanzania.

Summary: Acromegaly is a rare disease caused by hypersecretion of the growth hormone (GH). Most cases are caused by either pituitary microadenoma or macroadenoma. The GH producing tumors present with clinical manifestations of acromegaly due to excessive GH secretion or symptoms resulting from mass effects of the enlarging tumor. Read More

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Euglycemic Diabetic Ketoacidosis after a Single Dose of Empagliflozin in a Patient with Pancreatitis.

Clin Pract 2021 Apr 6;11(2):216-218. Epub 2021 Apr 6.

Internal Medicine Department, Centro Hospitalar de Entre o Douro e Vouga, 4520-211 Santa Maria da Feira, Portugal.

Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are the most recently approved drug class for the treatment of type 2 diabetes mellitus (T2D). Although they are largely well-tolerated, their intake has been associated with euglycemic diabetic ketoacidosis (DKA) in some rare cases. We report the case of a 70-year-old male with type 2 diabetes and no history of DKA, who started therapy with empagliflozin one day before presenting with acute pancreatitis and laboratory findings consistent with euglycemic DKA. Read More

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Spike in Diabetic Ketoacidosis Rates in Pediatric Type 2 Diabetes During the COVID-19 Pandemic.

Diabetes Care 2021 Apr 26. Epub 2021 Apr 26.

Diabetes & Obesity Program, Center for Endocrinology, Diabetes and Metabolism, Children's Hospital Los Angeles, Los Angeles, CA

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) on the incidence of new-onset type 2 diabetes and diabetic ketoacidosis (DKA) is unclear. It is unknown whether the coincidence of DKA noted in adult patients with type 2 diabetes is an issue for youth during the coronavirus disease 2019 pandemic.

Research Design And Methods: A retrospective single-center medical record review was conducted in a large, urban children's hospital of pediatric subjects presenting with new-onset type 2 diabetes between March and August of 2018 to 2020. Read More

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Clinical characteristics and outcome of hospitalized children and adolescent patients with type 1 diabetes during the COVID-19 pandemic: data from a single center surveillance study in Egypt.

J Pediatr Endocrinol Metab 2021 Jul 22;34(7):925-936. Epub 2021 Apr 22.

Division of Pediatric and Adolescent Diabetes Unit (PADU), Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt.

Objectives: COVID-19 pandemic significantly impacted the diagnosis of type 1 diabetes and its acute complications. Thus, the study aimed to evaluate the characteristics of pediatric patients with type 1 diabetes hospitalized during the first wave of the pandemic and the prevalence of new onset diabetes among patients with evidence of COVID-19 infection.

Methods: A single-center surveillance study included all patients with diabetes admitted to Children's Hospital, Ain Shams University, in Egypt between May to August 2020. Read More

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Prevention of diabetic ketoacidosis at diagnosis of type 1 diabetes: Are certified athletic trainers an untapped resource?

Endocrinol Diabetes Metab 2021 04 28;4(2):e00188. Epub 2020 Sep 28.

Department of Family and Community Medicine Penn State College of Medicine Hershey PA USA.

Aims: To assess the knowledge of certified athletic trainers (ATs) on the presenting signs and symptoms of type 1 diabetes (T1D).

Methods: We conducted a 31-question survey of secondary school ATs recruited from the National Athletic Training Association that established demographic information, knowledge of presenting signs and symptoms of T1D, and previous personal or professional exposure to individuals with T1D. We report descriptive statistics and univariate analyses evaluating the characteristics associated with T1D knowledge. Read More

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Pediatric diabetic ketoacidosis presenting with brain abscess.

J Pediatr Endocrinol Metab 2021 Jun 12;34(6):817-820. Epub 2021 Apr 12.

Pediatric Endocrinology, East Tennessee State University James H Quillen College of Medicine, Johnson City, Tennessee, USA.

Objectives: Report a novel case of new-onset type 1 diabetes in a pediatric patient presenting with DKA and concurrent brain abscess.

Case Presentation: The following case report is that of a previously healthy 12 year-old girl presenting with new-onset type 1 diabetes with mild diabetic ketoacidosis and subsequently found to have a brain abscess. Over the course of her hospital stay, she developed seizures and was found to have a 1. Read More

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Severe SARS-CoV-2 infection presenting with acute kidney injury and diabetic ketoacidosis complicated by pancreatitis in a 53-year man with hypertension.

Clin Case Rep 2021 Mar 7;9(3):1202-1206. Epub 2021 Jan 7.

Internal Medicine Department Hamad Medical Corporation Doha Qatar.

Severe COVID-19 infection is associated with significant stress and marked immune response that can affect many organs and precipitate DKA, pancreatitis, and acute renal injury, which might be permanent. Read More

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Is Misdiagnosis of Type 1 Diabetes Mellitus in Malaysian Children a Common Phenomenon?

Front Endocrinol (Lausanne) 2021 8;12:606018. Epub 2021 Mar 8.

Department of Paediatrics, University Malaya Medical Centre, Kuala Lumpur, Malaysia.

Background: Children with Type 1 diabetes (T1DM) commonly present in diabetic ketoacidosis (DKA) at initial diagnosis. This is likely due to several factors, one of which includes the propensity for T1DM to be misdiagnosed. The prevalence of misdiagnosis has been reported in non-Asian children with T1DM but not in Asian cohorts. Read More

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Diabetic ketoacidosis at type 1 diabetes diagnosis in children during the COVID-19 pandemic.

Pediatr Diabetes 2021 06 27;22(4):552-557. Epub 2021 Mar 27.

Division of Pediatric Endocrinology, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.

Objective: The COVID-19 pandemic has led to significant public health measures that have resulted in decreased acute pediatric care utilization. We evaluated whether the rate of severe presentations of new onset type 1 diabetes (DM1), such as, diabetic ketoacidosis (DKA) has changed since the COVID-19 public health measures were enacted.

Research Design And Methods: A retrospective chart review of children less than 18 years of age presenting with new onset DM1 during the pandemic period of March 17, 2020 to August 31, 2020 was conducted at two tertiary care pediatric hospitals in Alberta, Canada. Read More

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Faciobrachial Myoclonus as the Presenting Manifestation of Diabetic Keto-Acidosis.

Tremor Other Hyperkinet Mov (N Y) 2021 03 2;11. Epub 2021 Mar 2.

Department of Neuromedicine, Bangur Institute of Neurosciences, Institute of Neurosciences, Institute of Postgraduate Medical Education and Research & SSKM Hospital, Kolkata, India.

Background: Chorea and ballism are well-recognized acute potentially reversible movement disorders as the presenting manifestation of non-ketotic hyperglycemic states among older type-2 diabetics. Myoclonus as the form of presentation of diabetic keto-acidosis (DKA) in previously undiagnosed type-1 diabetic has never been reported before.

Case Report: We herein report the case of a 36-year-old previously healthy patient who presented with acute onset incessant faciobrachial myoclonus for 10 days. Read More

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Effect of COVID-19 on the clinical course of diabetic ketoacidosis (DKA) in people with type 1 and type 2 diabetes.

Endocr Connect 2021 Apr;10(4):371-377

University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.

Objective: COVID-19 in people with diabetes is associated with a disproportionately worse prognosis. DKA is an acute complication of diabetes with a mortality rate of approximately 0.67%. Read More

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Case Report: Insulin-Dependent Diabetes Mellitus and Diabetic Keto-Acidosis in a Child With COVID-19.

Front Pediatr 2021 10;9:628810. Epub 2021 Feb 10.

Division of Critical Care Medicine, Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States.

During the COVID pandemic, a surge in pediatric Type 1 Diabetes Mellitus (T1DM) cases appears to be occurring, potentially due to the presence of autoantibody-induced immune dysregulation triggered by COVID-19. We describe one such case in a previously healthy 7-year-old with asymptomatic COVID-19 presenting with a high nasopharyngeal SARS CoV-2 virus load, detectable COVID-19 IgG antibodies, diabetic keto-acidosis and islet cell autoantibodies. COVID-19 is not a trivial disease in children and adolescents and can lead to lifelong sequelae such as T1DM. Read More

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February 2021