Case 5-1973

Presentation of Case A 58-year-old woman was admitted to the hospital because of anemia. The patient had diabetes of 12 years' duration, regulated on NPH insulin. Seventeen years previously an area of cystic mastitis of the right breast was excised. For many years she had suffered from migraine and was treated with multiple agents that included methysergide. Nine months before entry she was brought to the hospital because of diabetic ketoacidosis complicated by gastrointestinal blood loss, for which no source was found; the creatinine ranged from 1.8 to 0.9 mg per deciliter. One month thereafter she returned in hyperosmolar coma, . . .