Abstract
In this review, we aim to outline the world’s experience with pediatric diabetic ketoacidosis (DKA) during and after the recent pandemic due to Covid-19. Although most of the literature during the pandemic illustrated the devastation wreaked on adults with diabetes, it took its toll on the pediatric population as well. Here we describe the incidence, prevalence, global impact, and varied presentations of Covid-19 related DKA. We opine on the mechanism of action or pathophysiology of pandemic related DKA, from direct viral effects to indirect mechanisms, such as inability to seek medical help and/or fear of seeking help at medical establishments that crucially kept children away from care only to present in worse states of chronic disease. The silver lining was the advent of telehealth and treatment of DKA in non-traditional settings that ironically broadened the scope of care. Lastly, we review areas in need of future study so that we are better prepared as pediatric clinicians for the next pandemic to protect the children in a more thorough and durable fashion. There are numerous lessons we have learned from this that we can apply now in our daily practice to improve the care we give to our patients.