부산대학교 도서관

A 48-year-old man was under insulin treatment for diabetes that had been diagnosed 8 years prior, but his treatment had been interrupted, and his glycemic control was poor. He was found to have disturbance of consciousness by his family and was taken to the emergency ward. After being transported to our medical center, he was diagnosed with diabetic ketoacidosis (DKA) based on the results of a blood test. His level of consciousness was E1V1M1 on the Glasgow Coma Scale. We noted significant brain edema on computed tomography and brain hypoperfusion on magnetic resonance imaging. We performed systemic control with fluid replacement and continuous insulin injection, and we administered glycerol for brain edema in parallel with treatment for complicated pneumonia using antimicrobial agents. His brain edema improved but eventually led to a vegetative state. Brain edema before treatment in hyperglycemic emergent adult patients, including those with DKA or hyperglycemic hyperosmolar syndrome (HHS), is extremely rarely reported, so we feel that this case is valuable and have thus duly reported it.