1978 Volume 21 Issue 3 Pages 227-232
A 34-year-old male was admitted to the emergency room due to hematemesis and anuria. No history of diabetes mellitus was indicated. Two days prior to admission he had complained of thirst and polyuria after playing golf, followed by oliguria and vomiting of a coffee-like fluid. Suspecting the presence of a peptic ulcer, immediate parenteral fluid therapy was begun, but drowsiness ensued. Twenty-four hours after admission, the patient was transferred to our Diabetes Center due to ketonuria and glucosuria. Intravenous and subcutaneous insulin therapy was initiated. About 13 hr later, despite an improvement of ketoacidosis, the patient remained drowsy. He then suddenly complained of severe abdominal and back pain, associated with hematemesis and melena; the abdominal wall was spastic, suggesting perforation of a peptic ulcer. However, following subcutaneous injection of an analgesic (scopolamine butylbromide, 20 mg), the acute abdominal symptoms disappeared and the patient's consciousness gradually became clear. Gastroscopic examination revealed multiple erosion and reddening of the antral mucosa. The mechanism of gastrointestinal hemorrhage accompanying diabetic ketoacidosis is discussed.
