糖尿病ケトアシドーシスに肺血栓塞栓症を合併した高齢1型糖尿病の1例  [in Japanese] A Case of Type 1 Diabetes Mellitus Complicated by a Pulmonary Thromboembolism during Treatment for Diabetic Ketoacidosis  [in Japanese]

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Abstract

症例は81歳女性.20歳で1型糖尿病と診断され,強化インスリン療法中であった.2011年8月31日意識障害を主訴に当院へ救急搬送された.血糖値は671 mg/d<i>l</i>,尿ケトン2+,代謝性アシドーシスを認め,糖尿病ケトアシドーシス(DKA)と診断,生理食塩水の補液と速効型インスリンの経静脈投与を行った.高血糖は順調に改善し,インスリンを皮下注射へ切り替えるとともに離床を開始した.第3病日に突然の呼吸困難をきたし,胸部CTにて両側肺動脈に造影欠損を認め,肺血栓塞栓症を併発したと判断した.ただちに抗凝固療法を行い,軽快退院した.DKAに肺血栓塞栓症を合併した論文報告は極めて少なく,いずれも肥満の2型糖尿病である.本症例は非肥満の1型糖尿病であり,DKAによる血液凝固能の亢進や血液粘稠度の増大,糖尿病長期罹病に伴う血管内皮障害が,肺血栓塞栓症の発症に関与した可能性が考えられた.<br>

An unconsciousness 80-year-old Japanese woman was admitted in August 2010. She had been treated with intensive insulin therapy since she was 20 years old because of type 1 diabetes mellitus. Urinalysis revealed ketonuria at the time of admission, and her blood glucose and HbA1c levels (NGSP value) were 671 mg/d<i>l</i> and 8.8 %, respectively. An arterial blood gas analysis showed metabolic acidosis. The intravenous administration of saline and insulin was initiated based on the diagnosis of diabetic ketoacidosis (DKA), and she became alert with an improvement in the hyperglycemia. She thereafter suddenly went into shock with dyspnea on the 3<sup>rd</sup> day after admission. She was diagnosed to have a pulmonary thromboembolism (PE) because enhanced CT showed that contrast material could not penetrate the bilateral pulmonary arteries. Anticoagulant drugs were immediately administered, and the clinical symptoms and thrombus disappeared. Although there have been a few reports of patients with DKA complicated with PE, she was the first such case of a non-obese patient with type 1 diabetes mellitus. Several factors, such as hyperviscosity and enhanced blood coagulation followed by severe dehydration and endothelial injury of the blood vessels caused by longstanding diabetes, were thought to be associated with the onset of PE in this case.<br>

Journal

  • Journal of the Japan Diabetes Society

    Journal of the Japan Diabetes Society 55(12), 993-997, 2012-12-30

    THE JAPAN DIABETES SOCIETY

References:  12

Codes

  • NII Article ID (NAID)
    10031170443
  • NII NACSIS-CAT ID (NCID)
    AN00166576
  • Text Lang
    JPN
  • Article Type
    NOT
  • ISSN
    0021437X
  • NDL Article ID
    024222704
  • NDL Call No.
    Z19-401
  • Data Source
    CJP  NDL  J-STAGE 
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