A Case of an Obese Patient With Fulminant Type 1 Diabetes Mellitus Accompanied by Cardiac Arrest Within 24 Hours After Acute Symptoms Due to Hyperglycemia Who Was Resuscitated in Pre-Hospital Care

Abstract

A 26-year-old man with obesity (body mass index [BMI] 34.6 kg/m²) who had never been diagnosed with diabetes mellitus presented to the emergency department of our hospital via doctor-helicopter after resuscitation from cardiac arrest. He had felt thirsty and shown polydipsia and polyuria the night before admission. On the day of admission, he had felt general malaise in the morning, and he had vomited and shown restlessness around noon. Laboratory findings were as follows: plasma glucose 1060 mg/dL; HbA1c 6.2 %; pH 6.835; HCO₃⁻ 6.0 mmol/L; 3-hydroxybutyrate 9685 μmol/L; K 7.5 mEq/L. These findings indicated diabetic ketoacidosis (DKA) and hyperkalemia. His urinary C-peptide reactivity (CPR) was 8.5 μg/day, serum CPR was 0.20 ng/mL before and after a glucagon-loading test, and anti-GAD, anti-IA-2 and anti-insulin antibodies were undetected, indicating a diagnosis of fulminant type 1 diabetes mellitus (FT1DM). The present findings should encourage physicians to consider FT1DM in the differential diagnosis of cardiac arrest and recognize the importance of pre-hospital medicine.