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Journal of Diabetes & Metabolic Disorders
Published in: Journal of Diabetes & Metabolic Disorders 1/2023

08-04-2023 | Acute Kidney Injury | Review Article

Risks associated with acute pancreatitis (AP) with diabetic ketoacidosis (DKA) in COVID-19 patients: a literature review

Authors: Sundru Manjulata Devi, Annapurna Pamreddy, Venkata Ramana Narendra

Published in: Journal of Diabetes & Metabolic Disorders | Issue 1/2023

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Abstract

Background

SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) has become a global pandemic, and medical experts are scrambling to understand the wide range of symptoms and consequences of the virus. Although acute pancreatitis (AP) and pancreatic damage have been associated with SARS-CoV-2, the mechanism behind this is still unclear. The current article explores whether COVID-19 is an additional cause of AP and diabetic ketoacidosis (DKA). The article illustrates the conditions associated with AP and DKA among COVID-19 patients and diabetes mellitus (DM). Another critical condition is acute kidney injury (AKI), often associated with DKA.

Methods

A search strategy for the article was assigned and retrieved from PubMed, Web of Science, and Scopus databases from 2020 to June 2022. The articles which discussed case studies on AP, DKA, and AKI were included in the study.

Results

The present review of 24 reported case studies represented conditions of AP (12), DKA (5), AP and DKA (5), AP and AKI (1), and DKA and AKI (1) among COVID-19 participants, and showed a potential relationship between the complications.

Conclusion

Healthcare during the COVID-19 pandemic plays a major role among AP, DKA, and AKI-associated COVID-19 patients. A compilation of case studies suggests effective management of COVID-19 infection-related complications such as AP, DKA, and AKI.
Literature
1.
2.
3.
Katulanda P, Dissanayake HA, Ranathunga I, Ratnasamy V, Wijewickrama PSA, Yogendranathan N, et al. Prevention and management of COVID-19 among patients with diabetes: an appraisal of the literature. Diabetologia. 2020;63:1440–52.PubMedPubMedCentralCrossRef
4.
Singh RR, Chhabra P, Kumta NA. Does hyperlipasemia predict worse clinical outcomes in COVID-19? A Multicenter Retrospective Cohort Study. J Clin Gastroenterol. 2022;56:e227–31.PubMedCrossRef
5.
Singh AK, Gupta R, Ghosh A, Misra A. Diabetes in COVID-19: prevalence, pathophysiology, prognosis and practical considerations. Diabetes Metab Syndr. 2020;14:303–10.PubMedPubMedCentralCrossRef
6.
7.
Wang F, Wang H, Fan J, Zhang Y, Wang H, Zhao Q. Pancreatic injury patterns in patients with coronavirus disease 19 pneumonia. Gastroenterology. 2020;159:367–70.PubMedCrossRef
8.
Bouchaala K, Bahloul M, Bradii S, Kallel H, Chtara K, Bouaziz M. Acute pancreatitis induced by diabetic ketoacidosis with major hypertriglyceridemia: report of four cases.Case Rep Crit Care. 2020:7653730.
9.
Ma LP, Liu X, Cui BC, Liu Y, Wang C, Zhao B. Diabetic ketoacidosis with acute pancreatitis in patients with type 2 diabetes in the emergency department: a retrospective study. Front Med (Lausanne). 2022;9:813083.PubMedCrossRef
10.
Nair S, Yadav D, Pitchumoni CS. Association of diabetic ketoacidosis and acute pancreatitis: observations in 100 consecutive episodes of DKA. Am J Gastroenterol. 2000;95:2795–800.PubMedCrossRef
11.
Pasquel FJ, Messler J, Booth R, Kubacka B, Mumpower A, Umpierrez G, et al. Characteristics of and mortality associated with diabetic ketoacidosis among US patients hospitalized with or without COVID-19. JAMA Netw Open. 2021;4:e211091–1.PubMedPubMedCentralCrossRef
12.
Pant N, Kadaria D, Murillo LC, Yataco JC, Headley AS, Freire AX. Abdominal pathology in patients with diabetes ketoacidosis. Am J Med Sci. 2012;344:341–4.PubMedCrossRef
13.
Huang Z, Xu Z, Xu R, Huang L, Xu X, Lai X. Whole exome sequencing identifies three novel gene mutations in patients with the triad of diabetic ketoacidosis, hypertriglyceridemia, and acute pancreatitis. J Diabetes. 2020;13:200–10.PubMedCrossRef
14.
Misra S, Oliver NS. Diabetic ketoacidosis in adults.BMJ. 2015;h5660.
15.
Bornstein SR, Dalan R, Hopkins D, Mingrone G, Boehm BO. Endocrine and metabolic link to coronavirus infection. Nat Rev Endocrinol Nature Publishing Group UK. 2020;16:297–8.CrossRef
16.
Ali E, Badawi M, Ahmed A, Abdelmahmuod E, Ibrahim W. 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;9:1202–6.PubMedPubMedCentralCrossRef
17.
Srinivasan A, Wilson B, Pansuriya T, Qasmi ST, Kesavan RB. Diabetic ketoacidosis and acute pancreatitis in Covid-19 setting. J Endocr Soc. 2021;5:A375–6.PubMedCentralCrossRef
18.
19.
Liu F, Long X, Zou W, Fang M, Wu W, Li W, et al. Highly ACE2 expression in pancreas may cause pancreas damage after SARS-CoV-2 infection. Clin Gastroenterol Hepatol. 2020;18(9):2128–30.PubMedPubMedCentralCrossRef
20.
Coate KC, Cha J, Shrestha S, Wang W, Gonçalves LM, Almaça J et al. SARS-CoV-2 cell entry factors ACE2 and TMPRSS2 are expressed in the pancreas but are not enriched in islet endocrine cells. 2020;2020.08.31.275719.
21.
22.
Manjili RH, Zarei M, Habibi M, Manjili MH. COVID-19 as an Acute inflammatory disease. J Immunol. 2020;205:12–9.PubMedCrossRef
23.
24.
Samanta J, Gupta R, Singh MP, Patnaik I, Kumar A, Kochhar R. Coronavirus disease 2019 and the pancreas. Pancreatology. 2020;20:1567–75.PubMedCrossRef
25.
Inamdar S, Benias PC, Liu Y, Sejpal D, Satapathy SK, Trindade AJ, et al. Prevalence, risk factors, and outcomes of hospitalized patients with coronavirus disease 2019 presenting as acute pancreatitis. Gastroenterology. 2020;159:2226–2228e2.PubMedCrossRef
26.
Buruk K, Ozlu T. New coronavirus: SARS-COV-2.Mucosa. 2020;1–4.
27.
Ding Y, He L, Zhang Q, Huang Z, Che X, Hou J, et al. Organ distribution of severe acute respiratory syndrome (SARS) associated coronavirus (SARS-CoV) in SARS patients: implications for pathogenesis and virus transmission pathways. J Pathol. 2004;203:622–30.PubMedPubMedCentralCrossRef
28.
Meireles PA, Bessa F, Gaspar P, Parreira I, Silva VD, Mota C, et al. Acalculous acute pancreatitis in a COVID-19 patient. Eur J Case Rep Intern Med. 2020;7:1710.
29.
Aloysius MM, Thatti A, Gupta A, Sharma N, Bansal P, Goyal H. COVID-19 presenting as acute pancreatitis. Pancreatology. 2020;20:1026–7.PubMedCrossRef
30.
31.
Chee YJ, Ng SJH, Yeoh E. Diabetic ketoacidosis precipitated by COVID-19 in a patient with newly diagnosed diabetes mellitus. Diabetes Res Clin Pract. 2020;164:108166.PubMedPubMedCentralCrossRef
32.
33.
Pal R, Banerjee M, Yadav U, Bhattacharjee S. Clinical profile and outcomes in COVID-19 patients with diabetic ketoacidosis: a systematic review of literature. Diabetes Metab Syndr. 2020;14:1563–9.PubMedPubMedCentralCrossRef
34.
Stevens JS, Bogun MM, McMahon DJ, Zucker J, Kurlansky P, Mohan S, et al. Diabetic ketoacidosis and mortality in COVID-19 infection. Diabetes Metab. 2021;47:101267.PubMedPubMedCentralCrossRef
35.
Gupta V. COVID-19 and Acute Pancreatitis: what do surgeons need to know? Indian J Surg. 2020;82:301–4.PubMedCrossRef
36.
Al Otair HA, Sheshah E, Al Shirah BZ, Jammah A. Diabetic ketoacidosis and new onset diabetes mellitus precipitated by COVID-19 infection. Juniper online Journal of Case studies. 2020;11(3):0069–71.
37.
Cheung KS, Hung IFN, Chan PPY, Lung KC, Tso E, Liu R, et al. Gastrointestinal manifestations of SARS-CoV-2 infection and virus load in fecal samples from a Hong Kong cohort: systematic review and Meta-analysis. Gastroenterology. 2020;159:81–95.PubMedCrossRef
38.
Kumaran NK, Karmakar BK, Taylor OM. Coronavirus disease-19 (COVID-19) associated with acute necrotising pancreatitis (ANP). BMJ Case Rep. 2020;13:e237903.PubMedPubMedCentralCrossRef
39.
Concepción Zavaleta MJ, Armas Flórez CD, Plasencia Dueñas EA, Coronado Arroyo JC. Diabetic ketoacidosis during COVID-19 pandemic in a developing country. Diabetes Res Clin Pract. 2020;168:108391.PubMedPubMedCentralCrossRef
40.
41.
Tollard C, Champenois V, Delemer B, Carsin-Vu A, Barraud S. An inaugural diabetic ketoacidosis with acute pancreatitis during COVID-19. Acta Diabetol. 2021;58:389–91.PubMedCrossRef
42.
Gadiparthi C, Bassi M, Yegneswaran B, Ho S, Pitchumoni CS. Hyperglycemia, hypertriglyceridemia, and Acute Pancreatitis in COVID-19 infection: clinical implications. Pancreas. 2020;49:e62–3.PubMedCrossRef
43.
Alhazzani W, Møller MH, Arabi YM, Loeb M, Gong MN, Fan E, et al. Surviving Sepsis Campaign: guidelines on the management of critically ill adults with Coronavirus Disease 2019 (COVID-19). Intensive Care Med. 2020;46:854–87.PubMedPubMedCentralCrossRef
44.
Batlle D, Soler MJ, Sparks MA, Hiremath S, South AM, Welling PA, et al. Acute kidney Injury in COVID-19: emerging evidence of a distinct pathophysiology. J Am Soc Nephrol. 2020;31:1380–3.PubMedPubMedCentralCrossRef
45.
Almutairi F, Rabeie N, Awais A, Samannodi M, Aljehani N, Tayeb S, et al. COVID-19 induced acute pancreatitis after resolution of the infection. J Infect Public Health. 2022;15:282–4.PubMedPubMedCentralCrossRef
46.
Hegyi P, Szakács Z, Sahin-Tóth M. Lipotoxicity and cytokine storm in severe acute pancreatitis and COVID-19. Gastroenterology. 2020;159:824–7.PubMedCrossRef
47.
Chamorro-Pareja N, Parthasarathy S, Annam J, Hoffman J, Coyle C, Kishore P. Letter to the editor: unexpected high mortality in COVID-19 and diabetic ketoacidosis. Metabolism. 2020;110:154301.PubMedPubMedCentralCrossRef
48.
Ferlicot S, Jamme M, Gaillard F, Oniszczuk J, Couturier A, May O et al. The spectrum of kidney biopsies in hospitalized patients with COVID-19, acute kidney injury, and/or proteinuria.Nephrol Dial Transplant. 2021;gfab042.
49.
Xu C, Zia U. Recovery from acute kidney injury with diabetic ketoacidosis following SARS-CoV-2 infection: a case report and literature review. Cureus. 2020;12:e11702–2.PubMedPubMedCentral
50.
51.
Legrand M, Bell S, Forni L, Joannidis M, Koyner JL, Liu K, et al. Pathophysiology of COVID-19-associated acute kidney injury. Nat Rev Nephrol. 2021;17:751–64.PubMedPubMedCentralCrossRef
52.
Hadi A, Werge M, Kristiansen KT, Pedersen UG, Karstensen JG, Novovic S, et al. Coronavirus Disease-19 (COVID-19) associated with severe acute pancreatitis: case report on three family members. Pancreatology. 2020;20:665–7.PubMedCrossRef
53.
Alloway BC, Yaeger SK, Mazzaccaro RJ, Villalobos T, Hardy SG. Suspected case of COVID-19-associated pancreatitis in a child. Radiol Case Rep. 2020;15:1309–12.PubMedPubMedCentralCrossRef
54.
Kataria S, Sharif A, Ur Rehman A, Ahmed Z, Hanan A. COVID-19 induced acute pancreatitis: a case report and literature review. Cureus. 2020;12:e9169–9.PubMedPubMedCentral
55.
56.
Pei G, Zhang Z, Peng J, Liu L, Zhang C, Yu C, et al. Renal involvement and early prognosis in patients with COVID-19 pneumonia. J Am Soc Nephrol. 2020;31:1157–65.PubMedPubMedCentralCrossRef
57.
58.
Alhumaid S, al Mutair A, al, Alawi Z, Rabaan AA, Alomari MA, al Salman SA, et al. Diabetic ketoacidosis in patients with SARS-CoV-2: a systematic review and meta-analysis. Diabetol Metab Syndr. 2021;13:120.PubMedPubMedCentralCrossRef
59.
Greenberg JA, Hsu J, Bawazeer M, Marshall J, Friedrich JO, Nathens A, et al. Clinical practice guideline: management of acute pancreatitis. Can J Surg. 2016;59:128–40.PubMedPubMedCentralCrossRef
60.
Mikulska M, Nicolini LA, Signori A, di Biagio A, Sepulcri C, Russo C, et al. Tocilizumab and steroid treatment in patients with COVID-19 pneumonia. PLoS ONE. 2020;15:e0237831–1.PubMedPubMedCentralCrossRef
61.
Morrison AR, Johnson JM, Ramesh M, Bradley P, Jennings J, Smith ZR. Acute hypertriglyceridemia in patients with COVID-19 receiving tocilizumab. J Med Virol. 2020;92:1791–2.PubMedPubMedCentralCrossRef
62.
63.
Rayman G, Lumb A, Kennon B, Cottrell C, Nagi D, Page E, et al. Guidance on the management of Diabetic Ketoacidosis in the exceptional circumstances of the COVID-19 pandemic. Diabet Med. 2020;37:1214–6.PubMedPubMedCentralCrossRef
64.
Chen J, Zeng H, Ouyang X, Zhu M, Huang Q, Yu W, et al. The incidence, risk factors, and long-term outcomes of acute kidney injury in hospitalized diabetic ketoacidosis patients. BMC Nephrol. 2020;21:48.PubMedPubMedCentralCrossRef
65.
Rubel AR, Chong PL, Abdullah MS, Asli R, Momin RN, Mani BI, et al. Lipemic serum in patients with Coronavirus Disease 2019 (COVID-19) undergoing treatment. J Med Virol. 2020;92:1810–1.PubMedPubMedCentralCrossRef
66.
Fu Y, Liu X, Cui B, Wang C, Liu Z, Zhao B. Clinical characteristics of Concomitant Diabetic Ketoacidosis in type 2 diabetes patients with Acute Pancreatitis. Diabetes Metab Syndr Obes. 2022;15:111–9.PubMedPubMedCentralCrossRef
67.
68.
Reddy PK, Kuchay MS, Mehta Y, Mishra SK. Diabetic ketoacidosis precipitated by COVID-19: a report of two cases and review of literature. Diabetes Metab Syndr. 2020;14:1459–62.PubMedPubMedCentralCrossRef
69.
Gorthi RS, Kamel G, Dhindsa S, Nayak RP. COVID-19 presenting with diabetic ketoacidosis: a case series. AACE Clin Case Rep. 2021;7:6–9.PubMedCrossRef
70.
Chandra R, Lazar NJ, Goldman S, Imam Z, Mansour R. Novel coronavirus (COVID-19) infection-attributed acute pancreatitis: a case report and literature review. Cureus. 2021;13:e15725–5.PubMedPubMedCentral
71.
Rabice SR, Altshuler PC, Bovet C, Sullivan C, Gagnon AJ. COVID-19 infection presenting as pancreatitis in a pregnant woman: a case report. Case Rep Womens Health. 2020;27:e00228–8.PubMedPubMedCentralCrossRef
72.
Alshahrani SM, Alshahrani NZ, Alakhali KM. COVID-19 triggers the incidence of diabetic ketoacidosis: a case report of uncontrolled type 2 diabetes mellitus. Int J of Pharmaceutical Res. 2021;13(1):3673–5.
73.
Eldaly AS, Fath AR, Mashaly SM, Elhadi M. Acute pancreatitis associated with severe acute respiratory syndrome coronavirus-2 infection: a case report and review of the literature. J Med Case Rep. 2021;15:461.PubMedPubMedCentralCrossRef
74.
Alfishawy M, Nassar M, Mohamed M, Fatthy M, Elmessiery RM. New-onset type 1 diabetes mellitus with diabetic ketoacidosis and pancreatitis in a patient with COVID-19. Sci Afr. 2021;13:e00915–5.PubMedPubMedCentral
75.
Acevedo-Mendez BA, Ye Y, Hajizadeh N, Myers A. Hypertriglyceridemia-Induced Acute Pancreatitis, Euglycemic Diabetic Ketoacidosis and COVID-19 infection in a patient with type 2 diabetes taking a sodium-glucose cotransporter 2 inhibitor. Cureus. 2021;13:e19828–8.PubMedPubMedCentral
76.
Razafindrazoto CI, Hasina Laingonirina DH, Ralaizanaka BM, Randriamifidy NH, Rakotomaharo M, Randrianiaina AF, et al. COVID-19 induced acute pancreatitis in a malagasy woman patient: case report and literature review. Int Med Case Rep J. 2022;15:125–34.PubMedPubMedCentralCrossRef
77.
Metadata
Title
Risks associated with acute pancreatitis (AP) with diabetic ketoacidosis (DKA) in COVID-19 patients: a literature review
Authors
Sundru Manjulata Devi
Annapurna Pamreddy
Venkata Ramana Narendra
Publication date
08-04-2023
Publisher
Springer International Publishing
Published in
Journal of Diabetes & Metabolic Disorders / Issue 1/2023
Electronic ISSN: 2251-6581
DOI
https://doi.org/10.1007/s40200-023-01207-3

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