Severe hyperglycemic shock associated with hepatic portal venous gas

We report a case of hyperglycemic shock associated with hepatic portal venous gas. A 79-year-old woman with post-stroke depression developed severe tachycardiac atrial fibrillation and hypotension due to hypovolemia caused by severe hyperglycemia, as well as showing disseminated intravascular coagulation (DIC). Continuous intravenous infusion of insulin and volume loading with normal saline gradually achieved normalization of the serum glucose level and hemodynamic stability. However, the DIC did not resolve, and abdominal computed tomography (CT) revealed hepatic portal venous gas (HPVG) in the left lobe of the liver. Surgery was thus considered mandatory. However, because severe hemodynamic lability occurred again immediately after the CT examination, and persisted, surgery could not be performed, and the patient died of septic shock due to bowel perforation. It was concluded that the underlying causes of DIC should be sought promptly, without delay.