[Case of fulminant type 1 diabetes mellitus complicated with acute renal failure treated with continuous hemodiafiltration]

Abstract

A 50-year-old male patient developed diabetic ketoacidosis with shock, acute renal failure treated with continuous hemodiafiltration (CHDF) and high serum CPK levels. Because of acute onset of ketoacidosis accompanied with an elevation of serum amylase, and negative findings of antibodies associated with autoimmune type 1 diabetes mellitus, he was diagnosed as a fulminant type 1 diabetes mellitus, which is a newly established subtype of type 1 diabetes mellitus. We managed to keep blood glucose concentrations within 150-200 mg x dl(-1) with continuous insulin intravenous infusion, and controlled circulation with dopamine. Since the blood glucose on admission was extremely high (1,870 mg x dl(-1)), the severe dehydration due to extreme hyperglycemia might have caused acute renal failure (ARF) and rhabdomyolysis. He was treated with CHDF for them. In a case of fulminant type 1 diabetes mellitus complicated with ARF early intensive support including CHDF for ARF must be considered in addition to intensive insulin therapy.