Posted on Authorea 18 Aug 2021 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.162927045.59295984/v1 — This a preprint and has not been peer reviewed. Data may be preliminary. el ybnigt C2rcpos hs eetr r rsn ntebd’ ao rasadtissues, and organs acute to major (5). lead may hyperglycemia body’s virus acute the The to in the (4). leading present kidneys enters cells, and are beta it intestine, receptors pancreatic and small of tissue, These (SARS-CoV-2) dysfunction adipose 2 cells, receptors. coronavirus pancreatic ACE2 lung, syndrome including to respiratory binding acute have by severe infections cells by asymptomatic caused but is dyspnea COVID-19 and manifestation coughs, group 3). severe fever, age (2, and by any common reported characterized most affect been the is can and also be It (COVID-19) rapidly to 2019 spreads infection. seems which disease COVID-19 Pneumonia China, Coronavirus of in manifestations. (1). pneumonia clinical different of world has cause the and the around as pandemic identified was a coronavirus becomes new a 2019, late In that such infection, COVID-19 by accelerated Introduction be can infancy, imperative. at becomes diabetes diagnosis of manifestation distinguished early an as DKA, diabetes neonatal Message Hyperglycemia, Clinical ketoacidosis), Key (diabetic DKA (COVID-19), 2019 clinical disease the Coronavirus in this consider neonatal should of we and presentation Keywords DKA, first of with ketoacidosis onset infant diabetic the with four-month accelerate complicated can context. in when COVID-19 DKA mortality that high and shows a diabetes COVID-19 causes of and concomitant infants in (DKA).The rare is mellitus Diabetes (DKA) ketoacidosis diabetic report Abstract with case infant a four-month-old a COVID-19: in by diabetes (DKA).The precipitating of context. ketoacidosis COVID-19 presentation clinical that diabetic the first shows in with The diabetes this complicated neonatal consider should of when we presentation mortality and first DKA, high with of infant a onset four-month the causes in accelerate and DKA can infants and COVID-19 in of rare concomitant is mellitus Diabetes Abstract 2021 18, August 3 2 1 Maleki Elham case a COVID-19: with report by infant precipitating four-month-old (DKA) a ketoacidosis in diabetic diabetes of presentation first The oaa nvriyo eia Sciences Medical of University Sciences Gonabad Medicine Medical of of Faculty University Sciences Kerman Medical of University Kerman 1 mrBaniasad Amir , 1 iaSepehran Mina , 1 2 n amhDavoudian Najmeh and , 3 Posted on Authorea 18 Aug 2021 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.162927045.59295984/v1 — This a preprint and has not been peer reviewed. Data may be preliminary. OI-9(1 5.Orkoldeo OI-9addaee ssillmtd h natwsdiagnosed by was infection infant with The association limited. its still and is diabetes diabetes 1 and the type COVID-19 of of of cells manifestation knowledge early Our the the enters endocrine 15). of the receptors (11, in reports COVID-19 these ACE2 few through of are Localization SARS-CoV-2 There (14). that (13). damage cells DKA suggests cell beta to causes cells pancreatic lead and to pancreatic can pancreas damage depletion the direct insulin but of known, acute region not and is infection study DKA the to their induces cases, due COVID-19 in two which reported other In by cases the mechanism the The in mellitus. Although, and diabetes infection. observed, diagnosed COVID-19 was another newly after In diabetes adults. COVID-19 diabetes and COVID-19. were with of by COVID-19 diagnosed infected between cases infant was concurrent three eight-month-old patient a an reported case, in (12) first DKA the of al. case et a Suwanwongse reported study, (11) al. et Soliman 10). PH (9, criteria: DKA biochemical the of following is neonatal the DKA as by cases, > known characterized some are In disorder and hyperglycemia. metabolic < cause neonatal a monogenic and is a infantile have DKA of life (7). cause of diabetes rare months of cases a manifestation six Most is first DKA. first was Diabetes the diabetes (6). in of manifestation diabetes present first that whose infant diabetes four-month-old a of admission, reported of we days study, 7 this In after and subsided and fever morning his the admission in Discussion of unit days one three to regularly After increased measured discharged. night. gradually was was at glucose was units he dose Blood night. half insulin at a patient’s units and The 1.5 one dose. was insulin patient patient. the the for the adjust insulin to for breastfeeding NPH started so his of resolved were dose Gradually, was starting was insulin COVID-19. DKA The (NPH) sugar days for the Hagedorn two blood started to after protamine and and was neutral transferred improved electrolytes, treatment subcutaneous was condition and signs, other general he and vital no and consciousness therapy, of of him supportive level monitoring patient for from Regular the started of Apart (PICU). was (RUL) performed. unit insulin lobe care intravenous upper intensive and right pediatric of fluids segment isotonic apical negative. with the Treatment were in cultures opacity patient. urine ground-glass febrile and Unifocal suspected blood 1: any reac- Figure of with segment chain results contact transcription-polymerase apical The report reverse SARS-COV-2. the not for for in did swab positive Parents opacity Nasopharyngeal ketoacidosis. was ground-glass 1). test diabetic (figure unifocal (rRT-PCR) and (RUL) tion reported hyperglycemia lobe air. was diabetic upper room scan confirmed right in of 1) (CT) 95% Table tomography of in computed saturation shown oxygen Chest (as and findings mmHg, 39 laboratory and 75/50 temperature The drowsiness, of were distress, pressure weight signs were respiratory vital blood measures had the minute, anthropometric the infant and per infant’s was cm The 180 admission, infant 63 Upon relative. The height admission. were kg, times. of Hospital parents several 5.5 time the vomiting Afzalipour the and and of at tachypnea, dehydration family department fever, severe the emergency of of history pediatric two-day child the a first to with presented Iran Kerman, was in boy infant four-month-old A accelerated ke- of diabetic cause was possible diabetes Presentation a as of Case patient. considered manifestation our is first in admission (DKA) whose after ketoacidosis infant infection diabetic four-month-old COVID-19 of a Diagnosis report toacidosis. to aimed study This mo i ruiektns[]+() netosaecmo n nw assta ceeaeteonset the accelerate that blood causes the known in and ketones common concomitant are of Infections presence (8). the [?]2+ and ketones mg/dl urine 200 or than lit greater / glucose 3mmol serum with and 15, 2 ° ,rsiaoyrt 2prmnt,hatrate heart minute, per 52 rate respiratory C, < .,SrmHCO3 Serum 7.3, Posted on Authorea 18 Aug 2021 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.162927045.59295984/v1 — This a preprint and has not been peer reviewed. Data may be preliminary. nr eed nAE n MRS n sBokdb lnclyPoe rtaeIhbtr Cell. Inhibitor. Cell Protease SARS-CoV-2 Proven Clinically al. a et by S, Blocked Erichsen Is T, ACE2 Herrler and of N, TMPRSS2 distribution Kruger and S, pathogenesis. ACE2 Tissue 2020;181(2):271-80.e8. Schroeder SARS on H. H, understanding Depends Goor Kleine-Weber in Entry van M, step G, Hoffmann first Navis A 5. AT, 2004;203(2):631-7. coronavirus. Lely pathology. SARS ML, of for Journal Bulthuis UK receptor The W, 133 functional 20 Timens the of prospective I, Features protein, 369:m1985. Protocol: Hamming al. 2020; Characterisation et Clinical ed). L, 4. research WHO with Norman (Clinical ISARIC Infant R, BMJ the Pius Old study. using HE, 35-Day cohort covid-19 Hardwick observational A with CA, F. hospital Green in Malekzadeh EM, patients Harrison N, AB, Davoudian Docherty E, 3. Heidari 2020;30(4):e103807. A, Pediatr. Baniasad J Iran M, COVID-19. Noghabi pneu- 2021;9(3):1663-6. Ekrami COVID-19 of reports. presentation 2. case Synchronous Clinical F. embolism. Abdollahi M, pulmonary proce- Mozdourian and N, monia Davoudian therapy F, Research” Poursadegh 1. the Biomedical reasonable upon in and author corresponding the Ethics References from obtained available are for study this been of Committee findings request. the support has National that data The “Iran parents the patient’s availability by Data the approved IR.KMU.AH.REC.1400.025). of been no.: (http://ethics.research.ac.ir/IndexEn.php, has consent dure informed The report. case this approval for Ethical source funding external no is There Funding interest. of article. conflict the no editing is and There manuscript the of interest draft of submitting initial Conflict and the editing of Authors in ND: collaboration and and AB patient the treating in the manuscript. involved editing the endocrinologist and writing other in the collaboration MS: and patient the treating in report. involved case endocrinologist the MS: and EL devastating have can of DKA infancy, immediately. onset and contributions at started COVID-19 the diabetes Author not of of accelerate manifestation is Concurrence early can treatment an infection. COVID-19 proper as COVID-19 if that DKA, to effects shows context. due clinical case, precipitated the in this be it can in consider should DKA, we and and DKA COVID-19 of combination The subcutaneous of diabetic order the was with with which discharged Conclusion association was of its and manifestation and treatment first home. ketoacidosis the at to of the well severity insulin antibodies, responded the negative patient Despite the and COVID-19. COVID-19, with age concomitant to and due ketoacidosis diabetes neonatal with 3 Posted on Authorea 18 Aug 2021 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.162927045.59295984/v1 — This a preprint and has not been peer reviewed. Data may be preliminary. iue1 nfclgon-ls pct nteaia emn frgtuprlb RL ftepatient the of (RUL) lobe Patient upper the right of of Data segment Laboratory apical the 1. Table in opacity ground-glass Unifocal 1. Figure Journal and 2020;33(9):1241-3. ketoacidosis diabetes. JPEM. caption(s): diagnosed diabetic Figure(s) newly Severe : with M. metabolism patient Nakhjavani & teenage H, endocrinology a Kouchak pediatric in Emadi of infection causes A, (COVID-19) and Rajab 2019 islets M, damages disease newly receptor coronavirus Hajmiri with its S, to patient Rabizadeh coronavirus SARS a 15. of 2010;47(3):193-9. in Binding diabetologica. LM. Covid-19 Guo Acta by XJ, diabetes. Ji 164:108166. precipitated acute SS, 2020; ketoacidosis Lin practice. JK, Diabetic Yang clinical and 14. E. research Yeoh Diabetes SJH, 93(2):1150-3. or mellitus. 2021; Causality Ng diabetes virology. YJ, COVID-19: diagnosed medical and Chee of DKA, Journal mellitus, cases. 13. diabetes three 2020; of diagnosed report Newly Parmensis. diabetes A N. Atenei 1 Shabarek coincidence? type : K, Newly-onset bio-medica Suwanwongse V. Acta 12. Sanctis of infant. De N, 8-month-old Mechanisms Hamed an print. N, of in al. 91(3):ahead Alaaraj COVID-19 et K, by Alleethy L, precipitated and M, mellitus Bouwens Al-Amri endocrinology AT, J, clinical Soliman of Ustinov 11. Journal R, The Nissinen P, beta-cells. 2000;85(1):432-40. Ylipaasto pancreatic metabolism. human S, to Sciences. Rasilainen of damage Academy M, coxsackievirus-induced York New Roivainen the of Annals 10. diabetes. and Viruses M. Consen- Herrath diabetes. 958:7-25. Practice Von Pediatric 2002; M, Clinical Manns ISPAD state. E, Jaeckel al. Diabetes hyperosmolar et 9. hyperglycemic A, al. the Rewers and R, et 27:155-77. Hanas ketoacidosis RN, Suppl M, Diabetic 2018;19 Fritsch Naylor M, 2018: 2017;40(10):e147-e8. M, Agus Guidelines Sanyoura care. N, sus Diabetes Glaser AM, JI, Ketoacidosis. Denson Wolfsdorf Diabetic clinical K, 8. of heterogeneity, Wroblewski Risk genetic High D, Infancy: Carmody infants: 2013;80(3):137-46. in and LR, paediatrics. Presentation in neonates Letourneau research in Hormone 7. mellitus options. Diabetes therapeutic and S. diagnosis, Ellard to O, approach Rubio-Cabezas 6. S m/)1 0-10 0.9-4.2 0-5 0.86-1.2 4.4-5.9 14 0.7 35.1-46.3 3.6-5.6 76.5 4-6.5 11.5-15.3 4.8 1 13-45 3.3 25 13-35 6.5 12.5 10-36 0.2-0.4 275 148 3.5-5.5 70-100 135-145 146 (ng/cc) 0.9 C-Peptide (mm/h) ESR (mg/dL) CRP 550 Range Reference 158 5 (mg/dL) Calcium (mg/dL) phosphorus Results (gr/dL) Albumin (seconds) PTT (seconds) PT INR (units/L) ALT (units/L) AST (gr/dL) Creatinine (mg/dL) Urea (mEq/lit) Potassium (mEq/lit) Sodium glucose Blood Investigations 4 Posted on Authorea 18 Aug 2021 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.162927045.59295984/v1 — This a preprint and has not been peer reviewed. Data may be preliminary. oyeaecanrato,SR-O-:svr ct eprtr ydoecrnvrs2 b antibody. Ab: 2, Erythrocyte coronavirus PCR: ESR: syndrome Hematocrit, respiratory protein, Hct: acute Hemoglobin, C-reactive severe Hb: CRP: cells, SARS-COV-2: blood reaction, ratio, time, Red chain RBC: normalized Polymerase thromboplastin cells, blood International Partial White WBC: INR: PTT: rate, sedimentation aminotransferase, time, Alanine Prothrombin ALT: PT: Aminotransferase, Aspartate AST: netgtosRslsRfrneRange Reference Results ( WBC Investigations B ( RBC c % 23 (min:31) 36 (11.1) 12.6 22 7.7 ( Platelet (%) Hct (gr/dL) Hb bouenurpi on ( count neutrophil Absolute H70 7.35-7.45 -2-(+2) 35-45 -26.5 7.01 22-28 19.1 - 4.5 0.1 - Negative Neg negative Neg +++severe - Excess Base positive (mmHg) pCO2 (mmol/L) Bicarbonate PH (VBG) gas blood Venous Ab Anti-Insulin titer Ab cell IU/ml Anti-islet Ab Decarboxylase Acid Anti-Glutamic SARS-COV-2 for assays PCR culture Urine culture Blood ketone Urine ( Lymphocyte × × 10 10 × 6 10 3 u)344.5-6.3 3.4 /uL) u)494-10 4.9 /uL) 9 × u)7 150-450 75 /uL) 10 3 u)108- 1.078 /uL) × 10 3 u)374- 3.724 /uL) 5 < 0.1 < < < 2.4 1/10 10