Abstract
A 37-year-old woman was admitted to our emergency room for disturbed consciousness. She had been diagnosed with type 1 diabetes mellitus at age 8 and received continuous subcutaneous insulin infusion therapy for 3 years. After admission, she was diagnosed with and treated for diabetic ketoacidosis (DKA), and her symptoms improved temporarily. Forty-eight hours after admission, however, she developed dyspnea and hypoxemia and was diagnosed with acute respiratory distress syndrome. She was intubated and placed on mechanical ventilation. However, life-threatening hypoxemia with a P/F ratio of 65 and massive serous tracheal discharge of ˜5 l/day persisted. We therefore decided to initiate veno venous extracorporeal membrane oxygenation (ECMO). Nine days after ECMO initiation, the patient was successfully weaned off ECMO; however, her health was subsequently complicated by a catheter-related bloodstream infection. This was followed by infectious endocarditis, and she died from septic shock and multiple organ dysfunction syndrome on day 35. There have been scarce clinical reports on acute respiratory distress syndrome secondary to DKA, but a very high mortality rate from infectious complications has been suggested. Our report indicates that introducing early ECMO as a rescue treatment for life-threatening hypoxemia in acute respiratory distress syndrome resulting from DKA is possible if the patient's ketoacidosis has been successfully controlled.
