Abstract
The patient was an 18-year-old obese male who had been consuming soft drinks in excess of 3L/day since the spring of 1993. In early October, he experienced difficulty breathing and was admitted to our hospital in a delirious state on October 14. His body mass index was 44.8 kg/m2, plasma glucose level was 1040 mg/dl, and severe metabolic acidosis was present. Neither IDDM-associated HLA types, islet-cell antibodies (ICA) or anti-GAD 65 antibodies were found. We made a diagnosis of diabetic ketoacidosis and immediately started intravenous insulin infusion and fluid replacement. Although the hyperglycemia improved, the metabolic acidosis did not, the dyspnea worsened, and oxygenation deteriorated rapidly. The patient died 10 hours after admission. At autopsy, the main pulmonary arteries were found to be obstructed by thrombi. In the pancreas, islets were decreased in number, but there was no insulitis. Severe loss of β-cells was prominent with aldehyde fuchsin staining. Mild diabetic nephropathy was also identified. These pathological findings suggest that glucose toxicity may produce morphological damage in pancreatic β-cells.
