敗血症性ショックをきたした糖尿病合併尿路感染症の1例

Abstract

A 70-year-old woman was admitted to our hospital because of fever and loss of consciousness. She had been quite well until the morning of the admission day, but then developed fever and became drowsy in several hours. On arrival at our hospital, her consciousness was "Ⅱ-10"(by Japan Coma Scale) and physical findings presented an impending shock state including very low blood pressure and oligouria. Laboratory examinations disclosed marked leukocytosis and elevation of C-reactive protein. Urine specimen contained some bacteria, and the culture studies demonstrated the growth of Escherichia coli, from both specimens of arterial blood and urine. We made a diagnosis of septic shock, probably originating in urinary infection. The patient recovered from the shock state in 24 hr during the period of intensive treatments including administration of dopamine and antibiotics "Piperacillin sodium". Repeated culture studies of blood and urine turned to be negative on the third day of the treatment period. No anatomical or physiologi- cal abnormality was demonstrated in the urinary tract. However, high levels of blood glucose and glucosuria were observed during the treatment. Although the glucose level was fairly controlled without any medication except diet therapy, the existence of diabetes mellitus might have been a triggering factor for urinary infection causing uroseptic shock.