An Autopsy Case of Ketoacidosis in Insulin Dependent Diabetes Mellitus Patient Complicated with Adult Respiratory Distress Syndrome, DIC and Leukopenia.
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A 37-year-old woman with insulin-dependent diabetes mellitus had been on insulin therapy (32 unit/day). She had cold on 5 February 1993, and stopped insulin injection because of nausea and dyspnea. On 10 February, she was admitted to our hospital because of progressive dyspnea. Her consciousness was clear, body temperature 37.7°C, respiratory rate 32/minute, blood pressure normal and dehydration mild. Plasma glucose was 501 was mg/d<I>l</I>, metabolic acidosis was present (PaO<SUB>2</SUB> 99.7 mmHg), WBC was 18400/mm<SUP>3</SUP>, and CRP was 20 mg/d<I>l</I>. No abnormal findings were found on chest X-ray and electrocardiogram. TAT and D-dimer were already increased on admission. We made a diagnosis of diabetic ketoacidosis and started intravenous insulin infusion and fluid replacement immediately. Although hyperglycemia and metabolic acidosis improved, dyspnea became worse, and hypoxia and leukopenia developed rapidly. Diffuse infiltrative shadows appeared in the chest X-ray with reduction in the platelet count 12 hours after treatment. We made a diagnosis of ARDS and DIC. Although treatment by mechanical ventilation with positive end expiratory pressure and Nafamostat was given, she died 35 hours after admission. Autopsy proved marked pulmonary edema compatible with ARDS, and bronchopneumonia with microabscesses caused by <I>Staphylococus aureus</I>. This is a rare case of diabetic ketoacidosis complicated with rapid progression of ARDS, DIC, and Leukopenia. It apperas that, in addition to infection, injury of the pulmonary capillaries and hypercoagulability and DIC related to her diabetic state and acidosis might have precipitated ARDS with the consequence of intrapulmonary sequestration of leukocytes.
- 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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