Abstract
We present a rare case of diabetic ketoacidosis in a hemodialysis patient. The patient was a 46-year-old man with a history of diabetes mellitus since the age of 25 years. He was diagnosed as having insulin-dependent diabetes mellitus (IDDM) with diabetic nephropathy in 1987. He had been undergoing maintenance hemodialysis therapy since August 1994. In October 1995, he developed an upper respiratory infection that caused anorexia. Because of this anorexia and fear of an insulin reaction, he stopped taking insulin entirely. He developed diabetic ketoacidosis with extreme hyperglycemia (serum glucose level, 1467mg/dl), acidosis, and ketonemia. The serum sodium concentration was 118mEq/l. On the Glasgow Coma Scale his consciousness level was 14 points, indicating that consciousness disturbance was almost entirely absent. Administration of large doses of insulin did not correct the hyperglycemia or acidemia. The hyperglycemia and acidosis were rapidly corrected by hemodialysis therapy. It is suggested that central venous system manifestation due to dehydration might be prevented by a lack of hyperglycemia-induced osmotic diuresis in a case of dialysis patient with diabetic ketoacidosis. Hemodialysis might be prefered for a rapid correction of ketoacidosis to a large dose of insulin.
