Open Access, Volume 2 Severe COVID pneumonia complicated with transient Diabetc ketoacidosis in a diabetes-naive patent: A case report and literature review Case Report www.jcimcr.org Journal of Clinical Images and Medical Case Reports Received: Aug 05, 2021 Accepted: Sep 10, 2021 Published: Sep 17, 2021 Archived: www.jcimcr.org Copyright: © Kumarihamy P (2021). *Corresponding Author: Prabhashini Kumarihamy Consultant Physician, Base Hospital, Teldeniya, Sri Lanka. Email: prabhashinikumarihamy@yahoo.com ISSN 2766-7820 Ashani Ratnayake 1 ; Prabhashini Kumarihamy 2 *; Sujeewa Gunaratne 2 ; Hiranya Abeysinghe 2 ; Navoda Wickramasinghe 3 1 Consultant Anaesthetc, Specialised COVID 19 treatment unit , Base Hospital, Teldeniya, Sri Lanka. 2 Consultant Physician, Specialised COVID 19 treatment unit, Base Hospital, Teldeniya, Sri Lanka. 3 Research Assistant, Specialised COVID 19 treatment unit, Base Hospital Teldeniya, Sri Lanka. Abstract A very few cases with Coronavirus disease (COVID-19) inducing Diabetc ketoacidosis in non-diabetc patents are reported. Hyper- glycaemia caused by transient damage to pancreatc cells by the virus and cytokine storm is identfed as the underlying pathophysiology. Here, we present a patent who presented with transient Diabetc ketoacidosis while being treated for COVID-19 pneumonia and is the frst reported case in Sri Lanka as per literature. We highlight the approach to diagnosis, monitoring and management of this patent which was challenging for the treatng physician. Case: A 34-year-old previously well Sri Lankan male presented with severe covid pneumonia. He was found to have diabetc ketoacidosis and managed as per protocol with fuid and insulin. His glycosylated haemoglobin was normal. Even though his Covid pneumonia wors- ened leading to death, he recovered from diabetc ketoacidosis and did not require exogenous insulin later in the course of the illness. Conclusion: Transient hyperglycemia with ketoacidosis, such as in our patent, associated with Covid infecton has been reported very rarely in the literature. The treatng physician should have a high in- dex of suspicion to diagnose these types of patents and to manage them tmely. Otherwise, it will be an added but a preventable factor to increase mortality in patents with Covid pneumonia. Keywords: coronavirus disease; COVID-19; non-diabetes; diabetes- naive; hyperglycemia; diabetc ketoacidosis. Abbreviatons: COVID -19: Coronavirus Disease; Fio2: Fracton Of In- spired Oxygen; Pao2: Partal Pressure Of Oxygen; Paco2- Partal Pres- sure Of Carbon Dioxide; HCO3: Bi Carbonate, DKA: Diabetc Ketoaci- dosis; IV: Intra Venous; KCL: Potassium Chloride; VBG: Venous Blood Gas; ICU: Intensive Care Unit; HFNO: High Flow Nasal Oxygen; NIV; Non-Invasive Ventlaton; PEEP: Positve End-Expiratory Pressure; CRP: C-Reactve Protein; ARDS: Acute Respiratory Distress Syndrome; ECMO: Extracorporeal Membrane Oxygenaton; ACE-2: Angiotensin Convertng Enzyme-2; TNF-Α: Tumour Necrosis Factor; IL-6- Interleu- kin 6.