![]() The liver and spleen were not palpable under the ribs, and bowel sounds were normal at 5 times/min. The abdomen was distended, without evidence of abdominal wall varices, and had tenderness throughout the entire abdomen. Heart rate was 155 beats/min, regular, with strong heart sounds and no murmurs. There was no resistance in the neck, coarse breath sounds were heard in both lungs without rales. The lips were not cyanotic, and there was congestion in the throat. There were deep and large respirations, dry skin, bilateral pupils of equal size and round shape at approximately 3.0 mm, with sensitive responses to light. Both her mother and grandmother had a history of diabetes but denied having a history of hyperlipidemia or coronary heart disease.Īdmission Physical Examination: Body temperature was 38℃, heart rate was 155 beats/min, respiratory rate was 38 breaths/min, blood pressure was 145/96 mmHg, body weight was 48 kg, oxygen saturation was 97%, and Glasgow Coma Scale score was 12 with a state of confusion and mental fatigue. Her father is in good health, while her mother died in 2021. The patient has no history of pancreatitis. After admission, further inquiry into the medical history revealed that the patient had experienced symptoms of polydipsia (> 2000 ml/d), polyuria (> 2500 ml/d, with 3–4 nighttime urinations), and weight loss (total decrease of 4 kg) over the past six months, but had not received any medical treatment. The patient has received two doses of the Sinovac COVID-19 vaccine and has no history of prior COVID-19 infection. ![]() The patient has had a history of close contact with a confirmed COVID-19 patient who had fever. ![]() Since the onset of her symptoms, the patient has had poor mental status and appetite, no bowel movement, increased urine output, and no significant change in weight. She was then admitted to our PICU on December 29, 2022. The patient was then transferred to our emergency department and had a rapid blood glucose test, which showed a result of 29.8 mmol/L. After about 4 h of receiving “fluid replacement, anti-infection, and omeprazole gastroprotection” treatment, however her symptoms did not improve. She received treatment at a local hospital where blood glucose and serum electrolyte levels were not measured. No fever, cough, diarrhea or other discomforts were present. Moreover, she exhibited deep and heavy breathing, dizziness and chest tightness. She had been vomiting six to seven times a day for the past day, with stomach contents, accompanied by difficult-to-relieve abdominal pain, poor mental state, which gradually worsened to a state of confusion. The case highlights the need for greater awareness and understanding of the interrelated and mutually promoting conditions of COVID-19, diabetes ketoacidosis, and acute pancreatitis among clinicians, to reduce misdiagnosis and missed diagnoses.Ī 12-year-old female patient was admitted to the hospital due to vomiting, abdominal pain for 1 day, and shortness of breath with consciousness disorder for half a day. The patient's symptoms improved, and blood glucose levels stabilized after 20 days of admission. Blood purification was administered to remove inflammatory mediators. The patient was treated with fluid resuscitation, insulin, anti-infection treatments, somatostatin, omeprazole, low-molecular-weight heparin, and nutritional support. Laboratory findings showed elevated levels of inflammatory markers, hypertriglyceridemia, and high blood glucose. The patient presented with vomiting, abdominal pain, shortness of breath, and confusion. We reported a case of acute pancreatitis associated with diabetic ketoacidosis in a 12-year-old female child post novel coronavirus infection. COVID-19-induced diabetes ketoacidosis and acute pancreatitis are extremely rare, with only four case reports in adults and no cases yet reported in children. There is a mutual influence between COVID-19, diabetes ketoacidosis, and acute pancreatitis, with clinical manifestations overlapping each other, which can lead to misdiagnosis and delayed treatment that could aggravate the condition and affect the prognosis.
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