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KMID : 0927720100110010079
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Korean Clinical Diabetes
2010 Volume.11 No. 1 p.79 ~ p.85
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A Case of Fulminant Type 1 Diabetes Combined with Early Detected Rhabdomyolysis
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Baek Jong-Ha
Lee Kyeong-Ju
Hahm Jong-Ryeal
Jung Jung-Hwa
Kim Soo-Kyoung
Chung Soon-Il
Jung Tae-Sik
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Abstract
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Fulminant type 1 diabetes is characterized by an abrupt onset, severe diabetic ketoacidosis at diagnosis and a relatively low HbA1c. Rhabdomyolysis is not uncommonly combined with diabetic ketoacidosis or hyperglycemic hyperosmolar coma. Rhabdomyolysis increases the development of acute renal failure and mortality of the patients with hyperglycemic diabetic emergency. A 34-year-old man presented with 2-days duration of oliguria, vomiting and lethargy. Formerly, he developed polyuria and flu-like symptoms such as generalized myalgia and headache for 7 days. Initial investigation showed metabolic acidosis (arterial pH 7.093, bicarbonate 5.1 mmol/L), severe hyperglycemia (glucose 1,576 mg/dL), a relatively low HbA1c (7.1%) and acute renal failure (blood urea nitrogen 77 mg/dL and creatinine 4.4 mg/dL). Both serum and 24-hour urine C-peptide levels were checked at very low range and islet autoantibody tests were all negative. Serum creatinine kinase was elevated to 2,397 U/L and urine myoglobin test was positive. The patient recovered from acute renal failure and rhabdomyolysis after fluid and insulin therapy. He discharged on admission 17th days and controlled diabetes by self injection of basal and bolus insulin.
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KEYWORD
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Fulminant, Rhabdomyolysis, Type 1 diabetes mellitus
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