Abstract
A case of diabetic coma associated with acute renal tubular necrosis is reported.
The patient was a 24-yr-old man. He had suffered from a common cold 2 weeks beforeadmission. His complaints on admission were abdominal pain, thirst, polyuria and weightloss. Hyperglycemia (1, 005 mg/dl) and acetonuria with metabolic acidosis (pH 7.1) indicated diabetic ketoacidosis. Continuous intravenous infusion of insulin (4 unit/hr) was begun immediately. However, he became oliguric and markedly edematous. Acute renal failure accompanied by severe hypermyoglobulinemia (23, 680 ng/ml) and a transient DIC (platelets 2.3 x 104/mm3, serum FDP 40 mg/dl) probably resulted from acute renal tubular necrosis, which was demonstrated by renal biopsy and spontaneously relieved after the performance of the 21st hemodialysis. The severe hypermyoglobulinemia may have derived not only from the ketoacidosis itself and circulatory disturbance, but also from direct invasion of viruses into the muscle tissues. This may represent a major factor contributory to the acute renal tubular necrosis.
