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KMID : 0371620010160010083
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Journal of Wonkwang Medical Science
2001 Volume.16 No. 1 p.83 ~ p.87
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Diabetic ketoacidosis associated with acute pancreatitis, rhabdomyolysis, acute renal failure and DIC
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Kim Ki-Hoon
Kweon Kyoung-Hee
Ahn Seon-Ho
Oh Seok-Kyu
Kim Tae-Hyun
Park Byoung-Hyun
Cho Chung-Gu
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Abstract
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The association of diabetic ketoacidosis(DKA) with acute pancreatitis and rhabdomyolysis is very rare and the mechanism is still unknown. We report a case of diabetic ketoacidosis associated with acute pancreatitis, rhabdomyolysis, acute renal failure and disseminated intravascular coagulation(DIC). A 43-year-old man suffering from abdominal pain, mental deterioration was admitted to our hospital. He was a type 2 diabetic patient for 13 years and had been omitting insulin administration during 5 days Laboratory data on admission revealed elevated serum levels of pancreatic enzymes, including amylase(195 IU/L), lipase(416 IU/L), as well as elevated serum levels of glucose (>600 ㎎/dL), myoglobin(>50 ㎎/dL), creatinine phosphokinase(7797 IU/L), lactate dehydrogenase(943 IU/L), blood urea nitrogen(75.2 ㎎/dL), creatinine(4.0 ㎎/dL). Thrombocytopenia, abnormal elevation of fibrin degradation product/D-dimer, ketonuria(+++) and myoglobinuria(> 500㎎/dL) were detected. Follow-up laboratory data shows further increase in amylase(403 IU/L) and lipase(1394 IU/L). Arterial blood gas analysis revealed pH 7.067, PaCO_2 25.5 ㎜Hg, PaO_2 112.7 ㎜Hg, HCO_3^- 7.2 mMol/L, Anion gap 25.4, SaO2 96.9%. Treatment with insulin and intravenous administration of electrolyte fluid was begun immediately. The patient completely recovered from renal failure, DKA, acute pancreatitis and DIC.
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KEYWORD
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diabetic ketoacidosis, acute pancreatitis, rhabdomyolysis, DIC
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