A Case of Severe Perceptive Deafness After Awakening from Diabetic Coma

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  • Uchimura Isao
    The Third Department of Internal Medicine, Tokyo Medical and Dental University School of Medicine
  • Iida Yoshitaka
    The Third Department of Internal Medicine, Tokyo Medical and Dental University School of Medicine
  • Sugiyama Hiromichi
    The Third Department of Internal Medicine, Tokyo Medical and Dental University School of Medicine
  • Sunaga Toshiaki
    The Third Department of Internal Medicine, Tokyo Medical and Dental University School of Medicine
  • Maezawa Hidenori
    The Third Department of Internal Medicine, Tokyo Medical and Dental University School of Medicine

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Other Title
  • 糖尿病性昏睡覚醒後高度難聴をきたした例
  • トウニョウビョウセイ コンスイ カクセイゴ コウド ナンチョウ オ キタシタ

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A 71 year-old male was admitted to our hospital in a semicoma which had occurred seven days after a high fever. At the age of 57, this patient had been diagnosed as having diabetes mellitus, but subsequently had received no medical care.<BR>The physiological and laboratory examination on admission to our hospital indicated that this was a case of severe diabetic coma with ketoacidemia and serum hyperosmolarity. Consequently, the patient received 4, 500ml. of fluid intravenously and 220 units of regular insulin within 12 hours after admission. This was followed by AB-Pc therapy against urinary tract infection and an intravenous administration of 700mg. of Furosemide against anuria. The patient recovered from diabetic coma, but revealed symptoms of deafness. This state remained unchanged throughout his three months of hospitalization.<BR>Audiometry disclosed severe bilateral perceptive deafness with bilateral vestibular disturbance, combined with transient nuchal rigidity, dysuria, and hypesthesia and muscular weakness in the legs. In this regard, the patient had experienced no hearing difficulties prior to his hospitalization.<BR>In view of the fact that this case of diabetic coma with ketoacidemia and serum hyperosmolarity was accompanied by neurological signs, the most probable cause of this hearing impairment was considered to be the disturbances in his inner ears and cranial nerves which followed the sudden normalization of serum osmolarity resulting from the therapy against diabetic coma.<BR>On the other hand, it is considered improbable that infection, any side effects of Furosemide, antibiotics, or diabetic angiopathy have constituted the cause of the hearing impairment.

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