A case of non-ketotic hyperosmolar diabetic coma with severe respiratory failure.
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A 29-year-old man with marked obesity, weighing 100kg, was admitted to our hospital in a stuporous state. In the last one month, he had complained of general fatigue and thirst. His vital signs were as follows: blood pressure 60/40mmHg, pulse rate 102/min, respiration rate 56/min with shallow breathing and tmperature normal. Laboratory data revealed a blood glucose level of 680 mg/d<I>l</I>, serum osmolarity 385 mOs/L, negative ketone bodies, Na 153 mEq/L, K 4.8mEq/L and Cl 120 mEq/L. Arterial gas analysis indicated a moderate metabolic acidosis with normal anion gap. He was diagnosed as a case of non-ketotic hyperosmolar diabetic coma (NHC) and was treated with a continuous intravenous infusion of Actrapid insulin and massive volume replacement by electrolyte fluids. However, the deterioration of acid-base balance continut d with progression of irespiratory failure and marked combined acidosis occurred. Positive end-expiratory pressure (PEEP) ventilation was immediately initiated. Improvement of acidosis was observed 1.5 h after the initiation of PEEP. Accordingly, the level of blood glucose was normalized. In this case, mechanical compression of the diaphragm by the marked obesity and gastrointestinal atony may have caused the ventilatory failure, thereby worsening the acidosis. Thus PEEP ventilation appeared to be effective in the treatment of NHC with respiratory failure. The levels of serum CPK and aldolase, which increased to 5040mU/In/ and 41.6mU/m<I>l</I>, respectively, on the first day of admission, gradually decreased and were normalized on the 15th day of admission. The mechanism of elevation of these enzymes was discussed.
- 一般社団法人 日本糖尿病学会の論文
一般社団法人 日本糖尿病学会 | 論文
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