Abstract
We report a case of IDDM associated with diabetic ketoacidosis and acute renal failure. A 28-year-old man was found in a semicoma 3 days after drinking a moderate amount of alcohol. His past history was non-contributory.
Marked hyperglycemia (1, 200 mg/dl), metabolic acidosis (pH 6.99), ketonuria, and elevation of serum pancreatic enzymes including amylase, trypsin and lipase were observed on admission. Insulin, fluid and FOY treatment were started immediately. In the early part of treatment, rhabdomyolysis with hypermyoglobinemia (221 ng/ml) and increased serum CPK (16, 100 IU/l) were observed. Hemodialysis was required to treat acute renal failure due to myoglobinemia.
He completely recovered from his acute renal failure and acute pancreatitis, but has needed insulin therapy continuously ever since. Although ICA (anti-islet cell antibody) was negative, we diagnosed IDDM on the basis of his HbAic (8.5%) and CPR (0.3 ng/ml) on admission. The relationship between acute pancreatitis and diabetic ketoacidosis was reviewed. In this case, a chain reaction is believed to have been triggered by alcohol ingestion at the onset of IDDM.
