Abstract
The patient was a woman in her 40s with type I diabetes mellitus, who presented with the chief complaint of consciousness disturbance. Findings at the first visit: GCS E3V2M5; no abnormal findings on physical examination or plain CT of the abdomen. The patient was diagnosed as having diabetic ketoacidosis (DKA) based on the following laboratory findings: blood glucose level, 1028 mg/dl; Base Excess (BE), -28.4 mmol/l. By 10 hours after hospitalization, the blood glucose level had decreased to 150 mg/dl and the patient became alert, however, the BE remained at -12.5 mmol/l. At 11 hours after admission, the patient began to complain of abdominal pain. A contrast-enhanced CT of the abdomen showed poor visualization of almost the entire small intestine. On angiography, occlusion of the superior mesenteric artery (SMA) was recognized, while the middle and right colic artery and some portions of the jejunal arteries could be visualized. As the family declined to provide consent for surgery, thrombolytic therapy was administered. While the thrombus in the SMA itself disintegrated, most of the jejunal and ileal arteries remained occluded, and the patient died at 41 hours after hospitalization. Since patients with DKA are at an increased risk of developing intraarterial thrombosis, early diagnosis and prompt treatment are extremely important in those with treatment-resistant abdominal pain and acidosis during the treatment, based on the possibility of intestinal ischemia.
