Abstract
A case of hyperosmolar nonketotic diabetic coma (HKNC) associatedd with rhabdomyolysis and increased serum levels of pancreatic enzymes and CA19-9 is reported. A 52-year-old man was admitted to our hospital because of consciousness disturbance. Thirst, polyuria, body weight loss appeared about 3 months before, and symptom of flu began a week before and then consciousness disturbance developed and the patient visited our hospital. On admission, mild consciousness disturbance (somnolence) and marked hyperglycemia, hyperosmolality were noted, however, urine ketone was negative and acidosis was not present. Creatine phosphokinase (CPK), myoglobin were markedly increased and mild elevations of blood urea nitrogen and creatinine were found. Moreover, increased levels of pancreatic enzymes (amylase, lipase, trypsin and elastase I) and increased serum level of CA19-9 were found without elevation of other tumor markers. A large amount of fluid and continuous intravenous insulin administration were started, with improvement of his hyperglycemia and consciousness disturbance in about 12 hours. CPK, myoglobin, various pancreatic enzymes and CA19-9 became normal within a month after admission. Serum levels of C-peptide and urinary excretion of C-peptide were found to be normal. Glycemic control of the patient was excellent with oral hypoglycemic agent when he was dicharged. Although elevations of various pancreatic enzymes were known to be associated during diabetic ketoacidosis, this is the first report showing the association of HKNC and elevated pancreatic enzymes and CA19-9.
