Successful Treatment of Diabetic Ketoacidosis, Incidental Hypothermia, and Takotsubo Syndrome after Fulminant Type 1 Diabetes Mellitus: A Case Report

Abstract

A 44-year-old man with no history of diabetes visited our emergency room in December X because of symptoms of fatigue and vomiting. On arrival, his blood glucose level was extremely high (2163 mg/dL), and his HbA1c was 6.3 %. A blood gas analysis showed metabolic acidosis (pH 6.866, HCO₃^- 4.6 mEq/L, BE -28.9 mEq/L) and high 3-hydroxybutyrate levels. Additionally, the patient's rectal temperature was 27 °C. The initial diagnosis was diabetic ketoacidosis (DKA) complicated by accidental hypothermia. Immediate treatment included massive fluid replacement, continuous intravenous insulin infusion, and extracorporeal rewarming therapy. One day after admission, the patient developed takotsubo cardiomyopathy (TTS) with ventricular tachycardia, prompting the introduction of percutaneous cardiopulmonary support. On the 4^th hospital day, his condition improved, and he was diagnosed with fulminant type 1 diabetes mellitus. After intensive insulin therapy, he was discharged on the 33^rd hospital day. We report the successful management of a case of DKA secondary to fulminant type 1 diabetes mellitus complicated by accidental hypothermia and TTS.