Case 35-2009: A 60-Year-Old Male Renal-Transplant Recipient with Renal Insufficiency, Diabetic Ketoacidosis, and Mental-Status Changes

A 60-year-old man with diabetes mellitus and a history of renal transplantation was admitted to this hospital because of mental-status changes, diarrhea, renal insufficiency, diabetic ketoacidosis, and hypotension. On examination, the patient appeared cachectic and confused. Ultrasonographic examination of the pelvis showed the transplanted kidney with a well-circumscribed, rounded, focal hypoechoic lesion within the upper pole. On the fourth hospital day, respiratory distress developed that required mechanical ventilation. A 60-year-old man with diabetes mellitus and a history of renal transplantation was admitted to the hospital because of mental-status changes, diarrhea, renal insufficiency, diabetic ketoacidosis, and hypotension. On the fourth hospital day, respiratory distress developed that required mechanical ventilation. Presentation of Case Dr. Peter P. Moschovis (Medicine and Pediatrics): A 60-year-old man with diabetes mellitus and a history of renal transplantation was admitted to this hospital because of mental-status changes, diarrhea, renal insufficiency, diabetic ketoacidosis, and hypotension. The patient was in his usual state of health, with chronic respiratory problems, until approximately 2 months before admission, when increasing fatigue, somnolence, and intermittent mild confusion developed, associated with diarrhea and decreasing glycemic control. Three weeks before admission, he was admitted to another hospital because of increasing orthopnea and paroxysmal nocturnal dyspnea. On examination, there were crackles in the bilateral midlung . . .