Diabetes Monit 2000;1(1):86-91.
당뇨병성 케톤산증에 병발한 횡문근융해증 1예
조정구, 박병현, 김기훈, 장근영, 형근영, 이명수, 최용원, 최경숙, 김상욱, 김경년, 정병학
A Case of Diabetic Ketoacidosis associated with Rhabdomyolysis. Acute Renal Failure.
Chung Gu Cho, Byoung Hyun Park, Ki Hoon Kim, Geun Young Jang, Geun Young Hyoung, Myeung Su Lee, Yong Won Choi, Kyong Suk Choi, Sang Wook Kim, Kyoung Nyeon Kim, Byung Hak Jung
Abstract
Since osmotic diuresis, which is provoked by a high renal glucose load, prevents the development of acute tubular necrosis; there have been a few case reports connecting diabetic ketoacidosis with acute renal failure. secondary to rhabdomyolysis. Rhabdomyolysis is a clinical and biochemical syndrome. resulting from skeletal muscle injury with release of muscle contents, specifically myoglobin into the plasma and it has been implicated as a major cause of acute renal failure. Rhabdomyolysis is diagnosed in the presence of myogloblnuria and raised level of serum creatinine phosphokinase (CPK). We report a case of diabetic ketoacidosis which developed acute renal failure secondary to rhabdomyolysis and myoglobinuria with review of the literature. A 67-year-old man suffering from somnolence was admitted to our hospital. He had had coughing, sputum, chills for 7 days prior to the onset of somnolence, He was a type 2 diabetic patient and had been omitting oral hypoglycemic agent for two months. Laboratory data on admission revealed elevated serum levels of glucose(>27mmol/L), myoglobin(>500ng/dL), creatinine phosphokinase(2.156IU/L), lactate dehydrogenase (1,679 IU/L), blood urea nitrogen (12.4 mmol/L) and creatinine (247 μmol/L). Ketone and myoglobin (75 ng/dL) was detected in urine. Arterial blood gas analysis revealed pH 7.104, PCO2 15mmHg, PO2 108.3mmHg, HCO3-4.8mmol/L. Chest film showed pneumonic consolidation on right lower lung, Treatment with subcutaneous insulin and intravenous administration of electrolyte fluid and the systemic antiobiotics was begun immediately. After initiation of treatment, there was increase in serum creatinine 0(707μmol/L), blood urea nitrogen (56.7 mmol/L), and anuria was observed. Despite of care. he died.
Key Words: Diabetlic ketoacidosis, Rhabdomyolysis, Acute renal faiure


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