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*Diarrhea is an uncommon gastrointestinal symptom in patients with COVID-19, but in may be the presenting symptom in few patients. The frequency of occurrence of diarrhea varies between 1%-35%. <ref name="pmid32253163">{{cite journal| author=Li XY, Dai WJ, Wu SN, Yang XZ, Wang HG| title=The occurrence of diarrhea in COVID-19 patients. | journal=Clin Res Hepatol Gastroenterol | year= 2020 | volume=  | issue=  | pages=  | pmid=32253163 | doi=10.1016/j.clinre.2020.03.017 | pmc=7270575 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32253163  }} </ref>It varies widely between different studies probably due to the different criteria used to define diarrhea.
* Greater percentage of occurrence was noted in patients with severe COVID-19 when compared to non-severe disease. Likewise, patients with gastrointenstinal symptoms were more likely to have severe respiratory disease with ARDS requiring ventilatory support. <ref name="pmid32213556">{{cite journal| author=Jin X, Lian JS, Hu JH, Gao J, Zheng L, Zhang YM | display-authors=etal| title=Epidemiological, clinical and virological characteristics of 74 cases of coronavirus-infected disease 2019 (COVID-19) with gastrointestinal symptoms. | journal=Gut | year= 2020 | volume= 69 | issue= 6 | pages= 1002-1009 | pmid=32213556 | doi=10.1136/gutjnl-2020-320926 | pmc=7133387 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32213556  }} </ref> <ref name="pmid32109013">{{cite journal| author=Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX | display-authors=etal| title=Clinical Characteristics of Coronavirus Disease 2019 in China. | journal=N Engl J Med | year= 2020 | volume= 382 | issue= 18 | pages= 1708-1720 | pmid=32109013 | doi=10.1056/NEJMoa2002032 | pmc=7092819 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32109013  }} </ref>
===Pathophysiology===
*SARS-CoV-2 uses the Angiotensin-converting enzyme 2 (ACE2) and the serine protease TMPRSS2 receptors for cell entry. These receptors are presently abundantly not only in the lungs but also in the enterocytes of the small intestinal.<ref name="pmid32278065">{{cite journal| author=D'Amico F, Baumgart DC, Danese S, Peyrin-Biroulet L| title=Diarrhea During COVID-19 Infection: Pathogenesis, Epidemiology, Prevention, and Management. | journal=Clin Gastroenterol Hepatol | year= 2020 | volume=  | issue=  | pages=  | pmid=32278065 | doi=10.1016/j.cgh.2020.04.001 | pmc=7141637 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32278065  }} </ref><ref name="pmid32102928">{{cite journal| author=Liang W, Feng Z, Rao S, Xiao C, Xue X, Lin Z | display-authors=etal| title=Diarrhoea may be underestimated: a missing link in 2019 novel coronavirus. | journal=Gut | year= 2020 | volume= 69 | issue= 6 | pages= 1141-1143 | pmid=32102928 | doi=10.1136/gutjnl-2020-320832 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32102928  }} </ref> Other sites of expression of the receptors in the gastrointestinal tract are-the upper esophagus, liver, and colon. <ref name="pmid32278065">{{cite journal| author=D'Amico F, Baumgart DC, Danese S, Peyrin-Biroulet L| title=Diarrhea During COVID-19 Infection: Pathogenesis, Epidemiology, Prevention, and Management. | journal=Clin Gastroenterol Hepatol | year= 2020 | volume=  | issue=  | pages=  | pmid=32278065 | doi=10.1016/j.cgh.2020.04.001 | pmc=7141637 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32278065  }} </ref>
*Entry of the virus causes disruption of the enterocytes and may lead to inflammation and alteration of intestinal permeability.
*COVID- 19 is being treated by atrial of many different antivirals and antibiotics. Diarrhea could also be a result of an alteration of the gut microbiota due to any of these. <ref name="pmid32096611">{{cite journal| author=Gao QY, Chen YX, Fang JY| title=2019 Novel coronavirus infection and gastrointestinal tract. | journal=J Dig Dis | year= 2020 | volume= 21 | issue= 3 | pages= 125-126 | pmid=32096611 | doi=10.1111/1751-2980.12851 | pmc=7162053 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32096611  }} </ref>


{{SK}} [[Diabetes]]; [[Diabetes insipidus]]; Diabetes insipidus; Congenital nephrogenic Diabetes insipidus; Cranial
===Clinical Features of Diarrhea caused by SARS-CoV-2===
Diabetes insipidus; nephrogenic
* According to Jin et al<ref name="pmid32213556">{{cite journal| author=Jin X, Lian JS, Hu JH, Gao J, Zheng L, Zhang YM | display-authors=etal| title=Epidemiological, clinical and virological characteristics of 74 cases of coronavirus-infected disease 2019 (COVID-19) with gastrointestinal symptoms. | journal=Gut | year= 2020 | volume= 69 | issue= 6 | pages= 1002-1009 | pmid=32213556 | doi=10.1136/gutjnl-2020-320926 | pmc=7133387 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32213556  }} </ref>, the definition of diarrhea was the passing of loose stools >3 times per day.
Diabetes insipidus; non-nephrogenic
* According to this study, 8.1% had diarrhea at onset and the symptoms lasted for approximately 4 days.
Diabetes insipidus; renal
* The duration of diarrhea ranged from 2-4 days with 3-8 bowel movements per day, according to various studies. <ref name="pmid32139552">{{cite journal| author=Song Y, Liu P, Shi XL, Chu YL, Zhang J, Xia J | display-authors=etal| title=SARS-CoV-2 induced diarrhoea as onset symptom in patient with COVID-19. | journal=Gut | year= 2020 | volume= 69 | issue= 6 | pages= 1143-1144 | pmid=32139552 | doi=10.1136/gutjnl-2020-320891 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32139552  }} </ref><ref name="pmid31986261">{{cite journal| author=Chan JF, Yuan S, Kok KH, To KK, Chu H, Yang J | display-authors=etal| title=A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster. | journal=Lancet | year= 2020 | volume= 395 | issue= 10223 | pages= 514-523 | pmid=31986261 | doi=10.1016/S0140-6736(20)30154-9 | pmc=7159286 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31986261 }} </ref>
Diabetes mellitus type 1
 
===Treatment===
==Definition==
* Supportive management is the mainstay of treatment.
Diabetes mellitus is a metabolic disease that results in dysregulation of blood sugar in the body.
* Rehydration, fluid repletion, and potassium monitoring are essential.
 
* Use of probiotics may have a role if the diarrhea is being caused by alteration of the gut microbiome. This could also be potentially useful in preventing secondary bacterial infections by restoring the gut microbiota. <ref name="pmid32096611">{{cite journal| author=Gao QY, Chen YX, Fang JY| title=2019 Novel coronavirus infection and gastrointestinal tract. | journal=J Dig Dis | year= 2020 | volume= 21 | issue= 3 | pages= 125-126 | pmid=32096611 | doi=10.1111/1751-2980.12851 | pmc=7162053 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32096611 }} </ref>
== Types ==
 
*Type 1 Diabetes Mellitus
*Type 2 Diabetes Mellitus
 
===Type 1 Diabetes Mellitus===
 
* Sudden onset
* Age: Any age, but mostly young
*  '''[[ketoacidosis]]''' common
* Endogenous insulin ''low'' or '''''absent'''''
 
=== Type 2 Diabetes mellitus===
 
* Gradual onset
* Age: Mostly adults
** May occur in younger individuals
* Ketoacidosis ''rare''
* Endogenous insulin may be
*# normal
*# increased or
*# decreased
 
== Symptoms ==
* [[Diabetes mellitus]] is usually [[asymptomatic]].
*[[Symptom|Symptoms]] of [[Diabetes]] may include the following:
:*[[Polyuria]]
:*[[Polydipsia]]
:*[[Polyphagia]]
:*[[Fatigue]]
 
==Pathophysiology==
Combination of factors
*Insulin deficiency
*Development of relative insulin resistance <ref name="pmid7555498">{{cite journal| author=Chen KW, Boyko EJ, Bergstrom RW, Leonetti DL, Newell-Morris L, Wahl PW | display-authors=etal| title=Earlier appearance of impaired insulin secretion than of visceral adiposity in the pathogenesis of NIDDM. 5-Year follow-up of initially nondiabetic Japanese-American men. | journal=Diabetes Care | year= 1995 | volume= 18 | issue= 6 | pages= 747-53 | pmid=7555498 | doi=10.2337/diacare.18.6.747 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7555498 }} </ref>
 
===Insulin resistance===
Insulin resistance may be due to an inherent genetic risk factor. Insulin resistance may become more severe with increasing weight and age. It results in impaired glucose tolerance and overt hyperglycemia. Overt hyperglycemia may itself result in a toxic effect on beta cells by decreasing insulin gene expression. <ref name="pmid9022089">{{cite journal| author=Moran A, Zhang HJ, Olson LK, Harmon JS, Poitout V, Robertson RP| title=Differentiation of glucose toxicity from beta cell exhaustion during the evolution of defective insulin gene expression in the pancreatic islet cell line, HIT-T15. | journal=J Clin Invest | year= 1997 | volume= 99 | issue= 3 | pages= 534-9 | pmid=9022089 | doi=10.1172/JCI119190 | pmc=507829 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9022089 }} </ref>

Latest revision as of 08:15, 19 June 2020

  • Diarrhea is an uncommon gastrointestinal symptom in patients with COVID-19, but in may be the presenting symptom in few patients. The frequency of occurrence of diarrhea varies between 1%-35%. [1]It varies widely between different studies probably due to the different criteria used to define diarrhea.
  • Greater percentage of occurrence was noted in patients with severe COVID-19 when compared to non-severe disease. Likewise, patients with gastrointenstinal symptoms were more likely to have severe respiratory disease with ARDS requiring ventilatory support. [2] [3]

Pathophysiology

  • SARS-CoV-2 uses the Angiotensin-converting enzyme 2 (ACE2) and the serine protease TMPRSS2 receptors for cell entry. These receptors are presently abundantly not only in the lungs but also in the enterocytes of the small intestinal.[4][5] Other sites of expression of the receptors in the gastrointestinal tract are-the upper esophagus, liver, and colon. [4]
  • Entry of the virus causes disruption of the enterocytes and may lead to inflammation and alteration of intestinal permeability.
  • COVID- 19 is being treated by atrial of many different antivirals and antibiotics. Diarrhea could also be a result of an alteration of the gut microbiota due to any of these. [6]

Clinical Features of Diarrhea caused by SARS-CoV-2

  • According to Jin et al[2], the definition of diarrhea was the passing of loose stools >3 times per day.
  • According to this study, 8.1% had diarrhea at onset and the symptoms lasted for approximately 4 days.
  • The duration of diarrhea ranged from 2-4 days with 3-8 bowel movements per day, according to various studies. [7][8]

Treatment

  • Supportive management is the mainstay of treatment.
  • Rehydration, fluid repletion, and potassium monitoring are essential.
  • Use of probiotics may have a role if the diarrhea is being caused by alteration of the gut microbiome. This could also be potentially useful in preventing secondary bacterial infections by restoring the gut microbiota. [6]
  1. ↑ Li XY, Dai WJ, Wu SN, Yang XZ, Wang HG (2020). "The occurrence of diarrhea in COVID-19 patients". Clin Res Hepatol Gastroenterol. doi:10.1016/j.clinre.2020.03.017. PMC 7270575 Check |pmc= value (help). PMID 32253163 Check |pmid= value (help).
  2. ↑ 2.0 2.1 Jin X, Lian JS, Hu JH, Gao J, Zheng L, Zhang YM; et al. (2020). "Epidemiological, clinical and virological characteristics of 74 cases of coronavirus-infected disease 2019 (COVID-19) with gastrointestinal symptoms". Gut. 69 (6): 1002–1009. doi:10.1136/gutjnl-2020-320926. PMC 7133387 Check |pmc= value (help). PMID 32213556 Check |pmid= value (help).
  3. ↑ Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX; et al. (2020). "Clinical Characteristics of Coronavirus Disease 2019 in China". N Engl J Med. 382 (18): 1708–1720. doi:10.1056/NEJMoa2002032. PMC 7092819 Check |pmc= value (help). PMID 32109013 Check |pmid= value (help).
  4. ↑ 4.0 4.1 D'Amico F, Baumgart DC, Danese S, Peyrin-Biroulet L (2020). "Diarrhea During COVID-19 Infection: Pathogenesis, Epidemiology, Prevention, and Management". Clin Gastroenterol Hepatol. doi:10.1016/j.cgh.2020.04.001. PMC 7141637 Check |pmc= value (help). PMID 32278065 Check |pmid= value (help).
  5. ↑ Liang W, Feng Z, Rao S, Xiao C, Xue X, Lin Z; et al. (2020). "Diarrhoea may be underestimated: a missing link in 2019 novel coronavirus". Gut. 69 (6): 1141–1143. doi:10.1136/gutjnl-2020-320832. PMID 32102928 Check |pmid= value (help).
  6. ↑ 6.0 6.1 Gao QY, Chen YX, Fang JY (2020). "2019 Novel coronavirus infection and gastrointestinal tract". J Dig Dis. 21 (3): 125–126. doi:10.1111/1751-2980.12851. PMC 7162053 Check |pmc= value (help). PMID 32096611 Check |pmid= value (help).
  7. ↑ Song Y, Liu P, Shi XL, Chu YL, Zhang J, Xia J; et al. (2020). "SARS-CoV-2 induced diarrhoea as onset symptom in patient with COVID-19". Gut. 69 (6): 1143–1144. doi:10.1136/gutjnl-2020-320891. PMID 32139552 Check |pmid= value (help).
  8. ↑ Chan JF, Yuan S, Kok KH, To KK, Chu H, Yang J; et al. (2020). "A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster". Lancet. 395 (10223): 514–523. doi:10.1016/S0140-6736(20)30154-9. PMC 7159286 Check |pmc= value (help). PMID 31986261.
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