Abstract:

Objective

To investigate the clinical features and treatment measures of diabetic ketoacidosis (DKA) complicated with hepatic portal venous gas (HPVG) secondary to corona virus disease 2019 (COVID-19).

Methods

The diagnosis and treatment process of a case of DKA combined with HPVG secondary to COVID-19 admitted to Lu’an Hospital of Traditional Chinese Medicine in February 2022 was analyzed, retrospectively, and relevant literature was reviewed.

Results

A 77-year-old male patient presented with respiratory symptoms as the first symptom on February 25th, 2022, and was diagnosed as COVID-19 after multiple positivity of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)nucleic acid (pharyngeal swab), and received symptomatic supportive treatment such as anti-infection and fluid rehydration in other hospitals. On February 27th, 2022, the patient’s symptoms worsened, accompanied by digestive tract symptoms such as poor appetite, abdominal distension, nausea and vomiting. Blood tests in our hospital indicated DKA, sepsis, acute kidney injury. Chest and abdomen computed tomography (CT)scan showed left pleural effusion with left inferior lung hypodilation and double pneumonia. Multiple gas accumulation in the portal vein and branches, multiple expansion of the abdominal intestine, gas accumulation and fluid accumulation, and different sizes of fluid, a small amount of fluid accumulation in the abdominal cavity, intestinal obstruction is considered. Emergency exploratory laparotomy was performed immediately after admission, and mechanical ventilation was given after operation. Meropenem (1.0 g, intravenous drip,one time every 8 h) combined with Linezolid (600 mg, intravenous drip, one time every 12 h) for antiinfection, phlegm reduction, fluid replenment, blood sugar control, stomach protection and electrolyte balance were also given. On the afternoon of February 28th, 2022, the patient developed a heart rhythm and died.

Conclusions

DKA secondary to COVID-19 combined with intestinal obstruction and HPVG is clinically rare in critical condition and have a high mortality rate. Clinicians need to improve their awareness of extrapulmonary complications of COVID-19, especially gastrointestinal symptoms, in order to get early diagnosis and treatment to improve the prognosis.

Key words: Corona virus disease 2019, Severe acute respiratory syndrome coronavirus 2, Hepatic portal vein gas, Diabetic ketoacidosis, Ileus, Septic shock, Severe pneumonia