Abstract
A 54-year-old man was admitted to our intensive care unit because of disturbed consciousness. He had been given a diagnosis of type 1 diabetes and was receiving long-term peritoneal dialysis. The blood sodium and glucose levels were 107 mmol/l and 1,452 mg/dl, respectively. Laboratory tests revealed infection and metabolic acidosis. Diabetic ketoacidosis (DKA) due to infection was diagnosed, but conventional fluid loading therapy for DKA could not be administered because of anuria. We initiated treatment with a continuous intravenous infusion of regular insulin and maintenance dosage of fluid. The blood glucose level was controlled by frequently adjusting the dose of insulin. Blood glucose levels and electrolyte levels were measured every hour to avoid overcorrection of hyperglycemia and hyponatremia. After blood glucose and electrolyte levels returned to the normal ranges, the patient regained consciousness. The findings suggested that a subcutaneous abscess was the focus of the infection, and therefore, we administered antibiotic therapy. The patient was successfully discharged from our hospital without neurologic complications by means of careful and mild corrections of electrolyte and glucose levels.
