id	author	title	date	pages	extension	mime	words	sentences	flesch	summary	cache	txt
cord-318038-psultpzy	José Concepción Zavaleta, Marcio	Diabetic ketoacidosis during COVID-19 pandemic in a developing country	2020-08-25		.txt	text/plain	545	39	54	We read with interest the study published by Goldman et al [1] , who identified four patients with diabetic ketoacidosis (DKA) resistant to standard therapy that was triggered by COVID-19 and was associated with high morbidity and mortality. The mechanism by which SARS-CoV-2 triggers DKA has not been fully elucidated; however, it has been shown that it uses the receptor for angiotensin-converting enzyme 2 as a gateway, which is expressed in the intestine, kidney, and pancreas [3] , organs that are part of the "egregious eleven," the pathophysiological basis of type 2 diabetes mellitus [4] . This damage can be expressed by an elevation of pancreatic enzyme levels in patients with COVID-19 [5] ; however, DKA itself can present with elevated pancreatic enzyme levels in 16%-25% of cases [6] . Likewise, a state of insulin resistance triggered by COVID-19 has been described, which, together with pancreatic injury, contributes to an increased risk of hyperglycemic crisis in patients with diabetes [3] . High prevalence of COVID-19-associated diabetic ketoacidosis in UK secondary care	./cache/cord-318038-psultpzy.txt	./txt/cord-318038-psultpzy.txt