A Case of Diabetic Ketoacidosis Associated with Acute Respiratory Distress Syndrome, Rhabdomyolysis and DIC

A 36-year-old man was hospitalized on February 24, 1997. On admission, his plasma glucose concentration was 973mg/dl, and arterial blood gas analysis revealed pH 6.981, PaCO₂ 17.8 mmHg, PaO₂ 63.8mmHg, HCO₃ 4.1mmol/l, indicating severe hyperglycemia with hypoxemia accompanying metabolic acidosis. Under a diagnosis of diabetic ketoacidosis (DKA), he was immediately transfused with fluid, insulin and antibiotics. He complained of dyspnea with progressive hypoxemia, and pulmonary edema developed about 6 hours after the initiation of treatment. As his general condition deteriorated rapidly, respiratory management using mechanical ventilation was started. Diffuse infiltrative shadows appeared on the chest X-ray with elevation of serum creatine kinase and serum creatinine concentrations and reduction of platelet count. We made a diagnosis of acute respiratory distress syndrome, rhabdomyolysis and DIC. With the treatment by mechanical ventilation with positive end expiratory pressure (PEEP), hemodialysis and the administration of urinastatin and gabexate, these situations gradually recovered in about a month. Our experience with this patient suggested that the mechanical ventilation with PEEP and the suitable treatment for other severe complications such as acute renal failure and DIC were important for the survival of these patients.