A case of emphysematous cholecystitis with marked hyperglycemia in a patient with type 2 diabetes

An 81-year-old man was admitted to our hospital due to disturbance of consciousness. He had a 10-year history of poorly controlled type 2 diabetes mellitus for which he was receiving insulin therapy. His wife found him lying on the floor at their home and called an ambulance. His consciousness level on admission was 11-20 on the Japan Coma Scale JCS). Laboratory analysis showed hyperglycemia and ketonuria, and analysis of arterial blood gases showed a pH of 7.274. Diabetic ketoacidosis and lactic acidosis were diagnosed. We administered physiologic saline and started continuous venous insulin infusion (CVII) therapy. Laboratory data showed a high white blood cell count and an elevated C-reactive protein concentration. An abdominal computed tomography (CT) scan was ordered to determine the cause of inflammation. Emphysematous cholecystitis was diagnosed, and emergency laparoscopic cholecystectomy was performed. After surgery, his blood glucose was stable, and CVII therapy was changed to biphasic insulin therapy. Clostridium perfringens was detected in a blood culture, and we began antibiotic therapy. His general condition and inflammation improved. In a patient with diabetic ketoacidosis and disturbance of consciousness, imaging studies are indicated when physical examination findings are unclear. In addition, therapy for diabetic ketoacidosis should be started immediately to prevent any complications during surgery.