Abstract
A 31-yr-old juvenile diabetic woman with 6 episodes of cardiorespiratory arrest is described. She had been treated irregularly with insulin for 14 yr before admission. Her history revealed ketoacidotic coma at 21 yr of age and brittle diabetes during these years. Physical examinations revealed severe diabetic complications including cataract, retinopathy to blindness, and anasarca due to nephropathy. In addition to the presence of sensory polyneuropathy, there were varied clinical symptoms associated with autonomic involvement. These consisted of orthostatic fainting, intractable vomiting, intermittent diarrhea, hypotonic bladder, etc.
The first cardiorespiratory arrest occurred following an injection of 5 mg diazepam used for alleviating recurrent vomiting one month after admission. External cardiac massage and assisted respiration under oxygen inhalation succeeded ineffecting rapid resuscitation. Six similar attacks have occurred in total without signs and symptoms of hypoglycemia or dysrhythmia. It was considered that continuous oral administration of diazepam might be one of the predisposing factors responsible for the repeated cardiorespiratory arrests.
Variations in beat-to-beat interval recorded with a cardiotachometer were examined on Valsalva's maneuver, deep breathing, standing, and with autonomic blocking agents such as propranolol and atropine sulfate. However, no significant changes in beat-to-beat variation were found in any of these tests. A fall in systolic blood pressure over 40 mmHg (diastolic over 20 mmHg) was observed after standing up, combined with a marked decrease in cardiac index.
It appears therefore that the cardiac autonomic innervation has been seriously impeded in this patient, and moreover, regulation of the cardiovascular reflex has been lacking. It is concluded that the principal cause of the repeated cardiorespiratory arrests may be closely associated with the cardiac denervated state.
Cardiorespiratory arrest due to diabetic autonomic neuropathy is rather rare. In fact, the present report may represent the first detailed description of such a case in Japan.
