MH. Lin, WJ. Ko, SR. Shih and CH. Wang (2012). Venoarterial extracorporeal membrane oxygenation resuscitation in diabetic ketoacidosis with hypothermic cardiocirculatory instability. The American journal of emergency medicine, 30(1), 259.e5-7. https://doi.org/10.1016/j.ajem.2010.11.003

PubMed 21185675

[Abstract]
Diabetic ketoacidosis with hypothermia is underrecognized, and the mortality rate is high at between 30% and 60%. The cause of hypothermia in diabetic ketoacidosis patients is speculative and has multiple factors. Insulin deficit is the most important factor that leads to a lack of substrate for cellular heat production. Water depletion and low environment temperature may also be contributing factors, especially in patients with a severe diabetic coma. Hypothermia may also aggravate uncontrolled diabetes mellitus and complicate treatment because insulin secretion is impaired and exogenous administered insulin is less effective at low temperatures. We present a case, the first in the literature, of severe diabetic ketoacidosis with marked hypothermia and cardiovascular instability that was successfully resuscitated by venoarterial extracorporeal membrane oxygenation support. Based on this report, we suggest that portable venoarterial extracorporeal membrane oxygenation should be considered to treat patients with severe diabetic ketoacidosis and hypothermic cardiocirculatory instability.