Diabetic Ketoacidosis Secondary to Fulminant Type 1 Diabetes Complicated by Acute Respiratory Distress Syndrome, Disseminated Intravascular Coagulation, Acute Renal Failure, and Rhabodmyolysis. Case Report

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  • 糖尿病性ケトアシドーシスで発症し，急性呼吸促迫症候群，急性腎不全，DIC, 横紋筋融解症を合併した劇症1型糖尿病の1例
  • 症例報告 糖尿病性ケトアシドーシスで発症し,急性呼吸促迫症候群,急性腎不全,DIC,横紋筋融解症を合併した劇症1型糖尿病の1例
  • ショウレイ ホウコク トウニョウビョウセイ ケトアシドーシス デ ハッショウ シ キュウセイ コキュウ ソクハク ショウコウグン キュウセイ ジンフゼン DIC オウモンキン ユウカイショウ オ ガッペイ シタ ゲキショウ 1ガタ トウニョウビョウ ノ 1レイ

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Fulminant type 1 diabetes mellitus is a recently established subtype of diabetes characterized by the abrupt onset of severe hyperglycemia and total loss of insulin secretion within days, often with elevated serum pancreatic enzyme levels and absence of islet cell antibodies. A 23-year-old woman presented with diabetic ketoacidosis (DKA), and after a few days of “flu” like symptoms, she was found to be obtunded at home and brought to the emergency room. On admission, DKA, renal failure, and rhabdomyolysis were diagnosed. The severe hyperglycemia and acidosis resolved by day 2 in response to intensive fluid therapy with insulin. Dyspnea occurred suddenly on day 3, and a chest X-ray revealed diffuse bilateral infiltrates compatible with acute respiratory distress syndrome (ARDS). Despite immediate mechanical ventilation and continuous hemofiltration, the hypoxia worsened on day 4. Percutaneous cardiopulmonary support was started, but there was no significant improvement and on day 7 it was replaced by VV-extra corporeal membrane oxygenation (ECMO). The hypoxia then gradually improved, and it was possible to wean the patient from ECMO and mechanical ventilation on day 10 and day 17, respectively. After rehabilitation, she was discharged on day 91 with mild fibular nerve paresis, but was able to perform self insulin injection and blood glucose monitoring.

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