Abstract
We report a case of diabetic ketoacidosis induced by acute pancreatitis in the course of noninsulin-dependent diabetes mellitus (NIDDM).
The patient was a 17-year-old man, who was calssified as having NIDDM with remarkableobesity (obesity index 1.41) and poor control of diabetes (HbA1c 13.4%).
On June 17, 1987, he was admitted to our hospital because of consciousness loss due to diabetic ketoacidosis accompanied by acute pancreatitis. By continuous intravenous insulin infusion, the blood glucose level was decreased from 950 to 271 mg/dl within 7 hours after admission. However, in spite of continuous intravenous insulin infusion (120-280 U/day), the blood glucose level fluctuated markedly between 80 and 600 mg/dl with a remarkably low level of serum IRI (9.5μU/ml). Following intravenous infusion of gabexate mesilate (1, 500 mg/day) for the treatment of disseminted intravascular coagulation (DIC), the daily insulin requirement was decreased gradually, and the level of serum IRI reached 29.1μU/ml by even low-dose insulin infusion (106 U/day). Unfortunately, he died of DIC, multiple organ failure and hypernatremia on June 29.
The present case demonstrated the following features;
(1) Diabetic ketoacidosis was induced by acute pancreatitis in NIDDM showing poor metabolic control.
(2) The complication of acute pancreatitis in NIDDM induced not only deterioration of metabolic control but also poor life prognosis.
