A Case of Type 1 Diabetes Mellitus Complicated by a Pulmonary Thromboembolism during Treatment for Diabetic Ketoacidosis

Abstract

An unconsciousness 80-year-old Japanese woman was admitted in August 2010. She had been treated with intensive insulin therapy since she was 20 years old because of type 1 diabetes mellitus. Urinalysis revealed ketonuria at the time of admission, and her blood glucose and HbA1c levels (NGSP value) were 671 mg/dl and 8.8 %, respectively. An arterial blood gas analysis showed metabolic acidosis. The intravenous administration of saline and insulin was initiated based on the diagnosis of diabetic ketoacidosis (DKA), and she became alert with an improvement in the hyperglycemia. She thereafter suddenly went into shock with dyspnea on the 3^rd day after admission. She was diagnosed to have a pulmonary thromboembolism (PE) because enhanced CT showed that contrast material could not penetrate the bilateral pulmonary arteries. Anticoagulant drugs were immediately administered, and the clinical symptoms and thrombus disappeared. Although there have been a few reports of patients with DKA complicated with PE, she was the first such case of a non-obese patient with type 1 diabetes mellitus. Several factors, such as hyperviscosity and enhanced blood coagulation followed by severe dehydration and endothelial injury of the blood vessels caused by longstanding diabetes, were thought to be associated with the onset of PE in this case.