Euglycemic Diabetic Ketoacidosis in a Patient with SARS-COV-2 Infection, a Stress Induced Complication or a Coronavirus Related Complication?

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infections have affected millions of persons around the globe since first described in December 2019. Coronavirus Disease (COVID-19) is primarily a respiratory tract infection and in severe cases may lead to pneumonia, acute respiratory distress syndrome and death. Diabetes mellitus comprises a serious comorbidity that has been associated with increased risk of adverse outcomes. In these patients, COVID-19 has been associated with increased risk of ketosis and ketoacidosis which is a life-threatening complication. Herein, we describe a case of a SARS-CoV-2 positive patient presenting with symptomatic euglycemic ketoacidosis soon after the initiation of a Sodium-Glucose Co-Transporter-2 (SGLT-2) inhibitor. Clinicians should be alert for diabetic ketoacidosis as a consequence of COVID-19 in the context of diabetes since early diagnosis and treatment may favorably affect outcome.