A Study to Compare Baseline Functional Residual Capacity and Forced Vital Capacity as Predictors of Mortality and Hospitalization in a Cohort of Mild to Moderate Interstitial Lung Disease
Olga R. Gomez Rojas, Ehsun Naeem, Filip Ionescu, Edward Castillo, and Girish B. Nair
Publication Date: 5-2022
Forced Vital Capacity (FVC) is a common parameter used to assess disease progression in patients with Interstitial lung disease (ILD) and acts as a surrogate for mortality. Previous studies suggest Functional Residual Capacity (FRC) may be an earlier predictor of disease progression in ILD. In this study, we compared predictive ability of baseline FRC to FVC to predict one-year-mortality and respiratory related hospitalization in patients with mild to moderate ILD
Diabetic Ketoacidosis Precipitated by COVID-19 Induced Acute Pancreatitis
Tamera Tennant and Bhavinkuma Dalal
Publication Date: 5-13-2022
Gastrointestinal manifestations of COVID-19 infection are increasingly being recognized, such as nausea, vomiting, and diarrhea. Research into the pathophysiology is ongoing. I present a case of a 52-year-old female without a history of diabetes who presented to the emergency room with progressive lethargy and altered mental status. Her tests results were consistent with diabetic ketoacidosis with glycemia 1440 mg/dL, venous pH 7.23, beta hydroxybutyrate of 7.53 mmol/L, bicarbonate 14 mmol/L, and anion gap 32. COVID-19 (SARSCoV- 2) testing by nucleic acid amplification was positive on admission. She was admitted to the intensive care unit and started on an insulin drip. Her severe abdominal pain led to the diagnosis of acute pancreatitis with lipase >1200 U/L and computed tomography of the abdomen showed inflammatory changes around the head of the pancreas and second portion of the duodenum. Workup for the cause of her pancreatitis was unrevealing. A right upper quadrant ultrasound negative for evidence of cholelithiasis, common bile duct dilation or liver abnormalities. She denied alcohol and drug use, which was confirmed with a negative blood alcohol level and urine drug screen on admission. Furthermore, she was not taking any medications prior to arrival, specifically those known to cause pancreatitis. She was diagnosed with diabetes mellitus during this admission and DKA was the presenting situation precipitated by COVID-19 pancreatitis. She was treated with intravenous fluids and supportive care. The remainder of her hospital stay was unremarkable. She was discharged home with an insulin regimen, and her HbA1C two months later was 8.3%. Follow-up CT of the abdomen one month after discharge showed no abnormalities. Literature review revealed a study in China reported an elevated incidence of pancreatic injury with few exhibiting hyperglycemia, and without a diagnosis of acute pancreatitis (1). There are few cases of acute pancreatitis that are classified as being caused by COVID-19 infection (2). However, none of these reported a complication of DKA. This case demonstrates pancreatitis and DKA as rare, yet possible, complications of COVID-19 and emphasizes the importance of thorough history-taking and diagnostic evaluation.
Printing is not supported at the primary Gallery Thumbnail page. Please first navigate to a specific Image before printing.