{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T18:18:14Z","timestamp":1783448294824,"version":"3.55.0"},"reference-count":29,"publisher":"Bioscientifica","issue":"1","license":[{"start":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T00:00:00Z","timestamp":1781481600000},"content-version":"vor","delay-in-days":165,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["journals.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,1,1]]},"abstract":"<jats:sec>\n                    <jats:title>Summary<\/jats:title>\n                    <jats:p>A 77-year-old Japanese woman with a history of spinocerebellar degeneration, recently diagnosed with mild glucose intolerance managed by diet, sustained blunt chest trauma from a fall 7 days before admission. Three days prior, she developed general fatigue, thirst, and polydipsia. On arrival, she was unconscious, with unmeasurable blood pressure; heart rate of 112 beats\/minute; and rectal temperature of 28\u00b0C. She presented with glucose levels of 1,125 mg\/dL; \u03b2-hydroxybutyrate of 13,778 \u03bcmol\/L; and arterial blood pH, 6.84, indicating severe diabetic ketoacidosis (DKA), likely triggered by traumatic hemothorax, and exhibited markedly elevated CA19-9 levels. External rewarming therapy was initiated along with vasopressor support, fluid resuscitation, continuous intravenous insulin infusion, and bicarbonate administration; subsequently, she regained consciousness. C-peptide depletion and positive islet-associated autoantibodies confirmed acute-onset type 1 diabetes mellitus. Although the CA19-9 level gradually decreased during hospitalization, it remained persistently above the reference range. Comprehensive imaging studies revealed no malignancy. Elevated CA19-9 levels were attributable to lung injury associated with traumatic hemothorax and multiple hepatic cysts. On hospital day 5, she was transferred to a general ward and resumed oral intake. Given the sustained improvement in glycemic control, she was transferred to another facility on hospital day 32. We report a rare case of acute-onset type 1 diabetes in an older patient who survived severe hypothermia and DKA secondary to traumatic hemothorax through intensive medical management. Appropriate and timely treatment can lead to favorable outcomes even in older patients with severe DKA and hypothermia. Furthermore, type 1 diabetes should be considered in elderly individuals presenting with newly developed glucose intolerance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Learning points<\/jats:title>\n                  <\/jats:sec>","DOI":"10.1530\/edm-25-0099","type":"journal-article","created":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T13:00:50Z","timestamp":1769778050000},"update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-2","source":"Crossref","is-referenced-by-count":0,"title":["Acute-onset type 1 diabetes in an older patient with severe hypothermia and diabetic ketoacidosis (pH 6.84) triggered by traumatic hemothorax"],"prefix":"10.1530","volume":"2026","author":[{"given":"Hono","family":"Kawashima","sequence":"first","affiliation":[{"name":"1"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4253-3465","authenticated-orcid":true,"given":"Mayu","family":"Watanabe","sequence":"additional","affiliation":[{"name":"1"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Momoka","family":"Hasegawa","sequence":"additional","affiliation":[{"name":"1"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akihiro","family":"Katayama","sequence":"additional","affiliation":[{"name":"1"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomoko","family":"Yamanoi","sequence":"additional","affiliation":[{"name":"2"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masaya","family":"Takeda","sequence":"additional","affiliation":[{"name":"1"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Satoshi","family":"Nogami","sequence":"additional","affiliation":[{"name":"2"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazuyuki","family":"Hida","sequence":"additional","affiliation":[{"name":"1"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"416","published-online":{"date-parts":[[2026,1,30]]},"reference":[{"key":"2026070713545126800_bib1","doi-asserted-by":"crossref","first-page":"1933","DOI":"10.1007\/s11739-024-03818-x","article-title":"Optimising risk stratification in diabetic ketoacidosis: a re-evaluation of acid-base status and hyperosmolarity using observational data","volume":"20","author":"Blank","year":"2025","journal-title":"Intern Emerg Med"},{"key":"2026070713545126800_bib2","doi-asserted-by":"crossref","first-page":"1833","DOI":"10.3390\/medicina60111833","article-title":"Predictors and predictive score of in-hospital mortality in diabetic ketoacidosis: a retrospective cohort study","volume":"60","author":"Munsakul","year":"2024","journal-title":"Medicina"},{"key":"2026070713545126800_bib3","doi-asserted-by":"crossref","first-page":"395.e5\u2013e6","DOI":"10.1016\/j.ajem.2013.10.042","article-title":"Managing combined critical hypothermia, diabetic ketoacidosis and cocaine intoxication noninvasively","volume":"32","author":"Freundt","year":"2014","journal-title":"Am J Emerg Med"},{"key":"2026070713545126800_bib4","doi-asserted-by":"crossref","first-page":"342","DOI":"10.1016\/j.ijsu.2018.02.058","article-title":"Risk factor, early diagnosis and overall survival on outcome of association between pancreatic cancer and diabetes mellitus: changes and advances, a review","volume":"52","author":"Khadka","year":"2018","journal-title":"Int J Surg"},{"key":"2026070713545126800_bib5","doi-asserted-by":"crossref","first-page":"232 e1","DOI":"10.1016\/j.ajem.2024.01.006","article-title":"Euglycemic diabetic ketoacidosis following traumatic brain injury","volume":"77","author":"Jang","year":"2024","journal-title":"Am J Emerg Med"},{"key":"2026070713545126800_bib6","doi-asserted-by":"crossref","DOI":"10.1097\/MD.0000000000043562","article-title":"Euglycemic DKA in a DPP-4 inhibitor patient following traumatic brain injury: a complex ICU glucose management challenge","volume":"104","author":"Shammas","year":"2025","journal-title":"Medicine"},{"key":"2026070713545126800_bib7","doi-asserted-by":"crossref","DOI":"10.1136\/bcr-2023-254649","article-title":"Surviving cardiac arrest from severe metformin-associated lactic acidosis using extracorporeal membrane oxygenation and double continuous venovenous haemodialysis","volume":"16","author":"Akkaoui","year":"2023","journal-title":"BMJ Case Rep"},{"key":"2026070713545126800_bib8","doi-asserted-by":"crossref","first-page":"551","DOI":"10.1001\/archsurg.1969.01340110043001","article-title":"Acid-base disturbances in hemorrhagic shock. In 66 severely wounded patients prior to treatment","volume":"98","author":"Cloutier","year":"1969","journal-title":"Arch Surg"},{"key":"2026070713545126800_bib9","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1186\/s13054-025-05368-w","article-title":"Adjuvant therapies for management of hemorrhagic shock: a narrative review","volume":"29","author":"Daniel","year":"2025","journal-title":"Crit Care"},{"key":"2026070713545126800_bib10","doi-asserted-by":"crossref","first-page":"1455","DOI":"10.1007\/s00125-024-06183-8","article-title":"Hyperglycaemic crises in adults with diabetes: a consensus report","volume":"67","author":"Umpierrez","year":"2024","journal-title":"Diabetologia"},{"key":"2026070713545126800_bib11","doi-asserted-by":"crossref","first-page":"e519","DOI":"10.1161\/CIR.0000000000001281","article-title":"2024 American Heart Association and American Red Cross Guidelines for first aid","volume":"150","author":"Hewett Brumberg","year":"2024","journal-title":"Circulation"},{"key":"2026070713545126800_bib12","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1186\/s13049-016-0303-7","article-title":"Accidental hypothermia-an update: the content of this review is endorsed by the International Commission for Mountain Emergency Medicine (ICAR MEDCOM)","volume":"24","author":"Paal","year":"2016","journal-title":"Scand J Trauma Resusc Emerg Med"},{"key":"2026070713545126800_bib13","doi-asserted-by":"crossref","first-page":"39","DOI":"10.2478\/jccm-2023-0004","article-title":"Brief report: diabetic keto-acidosis (DKA) induced hypothermia may be neuroprotective in cardiac arrest","volume":"9","author":"Shiber","year":"2023","journal-title":"J Crit Care Med"},{"key":"2026070713545126800_bib14","doi-asserted-by":"crossref","first-page":"326","DOI":"10.1016\/j.diabres.2012.01.013","article-title":"Diabetic ketoacidosis accompanied by hypothermia: a case report","volume":"96","author":"Nambu","year":"2012","journal-title":"Diabetes Res Clin Pract"},{"key":"2026070713545126800_bib15","doi-asserted-by":"crossref","first-page":"341.e5\u2013e6","DOI":"10.1016\/j.ajem.2017.10.057","article-title":"Metformin intoxication: vasopressin's key role in the management of severe lactic acidosis","volume":"36","author":"Galiero","year":"2018","journal-title":"Am J Emerg Med"},{"key":"2026070713545126800_bib16","doi-asserted-by":"crossref","first-page":"1276","DOI":"10.1007\/s00134-004-2283-8","article-title":"Role of vasopressin in the management of septic shock","volume":"30","author":"Mutlu","year":"2004","journal-title":"Intensive Care Med"},{"key":"2026070713545126800_bib17","doi-asserted-by":"crossref","first-page":"543","DOI":"10.4103\/0971-9784.166464","article-title":"Pharmacologic agents for acute hemodynamic instability: recent advances in the management of perioperative shock \u2013 a systematic review","volume":"18","author":"Morozowich","year":"2015","journal-title":"Ann Card Anaesth"},{"key":"2026070713545126800_bib18","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1056\/NEJM200101253440404","article-title":"Risk factors for cerebral edema in children with diabetic ketoacidosis. The Pediatric Emergency Medicine Collaborative Research Committee of the American Academy of Pediatrics","volume":"344","author":"Glaser","year":"2001","journal-title":"New Engl J Med"},{"key":"2026070713545126800_bib19","doi-asserted-by":"crossref","DOI":"10.1002\/cmdc.202400491","article-title":"Tumor-associated carbohydrate antigen 19-9 (CA 19-9), a promising target for antibody-based detection, diagnosis, and immunotherapy of cancer","volume":"19","author":"Nakisa","year":"2024","journal-title":"ChemMedChem"},{"key":"2026070713545126800_bib20","first-page":"135","article-title":"Polycystic liver disease: pathophysiology, diagnosis and treatment","volume":"14","author":"Norcia","year":"2022","journal-title":"Hepat Med"},{"key":"2026070713545126800_bib21","doi-asserted-by":"crossref","first-page":"1389","DOI":"10.1111\/j.1478-3231.2009.02055.x","article-title":"Carbohydrate antigen 19-9 is extremely elevated in polycystic liver disease","volume":"29","author":"Waanders","year":"2009","journal-title":"Liver Int"},{"key":"2026070713545126800_bib22","doi-asserted-by":"crossref","first-page":"506","DOI":"10.1002\/1097-0142(19900201)65:3<506::AID-CNCR2820650322>3.0.CO;2-0","article-title":"Normal bronchial mucus contains high levels of cancer-associated antigens, CA125, CA19-9, and carcinoembryonic antigen","volume":"65","author":"Matsuoka","year":"1990","journal-title":"Cancer"},{"key":"2026070713545126800_bib23","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1002\/jcla.20136","article-title":"Serum levels of CA19-9 in patients with nonmalignant respiratory diseases","volume":"21","author":"Kodama","year":"2007","journal-title":"J Clin Lab Anal"},{"key":"2026070713545126800_bib24","article-title":"Prognostic role of serum CA-125 and CA19-9 in lung transplant candidates with interstitial lung disease: a retrospective cohort study","volume":"12","author":"Izhakian","year":"2025","journal-title":"BMJ Open Respir Res"},{"key":"2026070713545126800_bib25","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1111\/jdi.12119","article-title":"Diagnostic criteria for acute-onset type 1 diabetes mellitus (2012): Report of the Committee of Japan Diabetes Society on the research of fulminant and acute-onset type 1 diabetes mellitus","volume":"5","author":"Kawasaki","year":"2014","journal-title":"J Diabetes Investig"},{"key":"2026070713545126800_bib26","doi-asserted-by":"crossref","first-page":"4092","DOI":"10.1111\/dom.16480","article-title":"Partial remission of type 1 diabetes: do immunometabolic events define the honeymoon period?","volume":"27","author":"Collier","year":"2025","journal-title":"Diabetes Obes Metab"},{"key":"2026070713545126800_bib27","doi-asserted-by":"crossref","first-page":"290","DOI":"10.2169\/internalmedicine.5567-25","article-title":"Continuously high titers of multiple islet-associated autoantibodies in an individual with an elderly onset of type 1 diabetes mellitus and Basedow's disease: a case report with a review of literature","volume":"65","author":"Ohnishi","year":"2026","journal-title":"Intern Med"},{"key":"2026070713545126800_bib28","doi-asserted-by":"crossref","first-page":"483","DOI":"10.1055\/s-2007-981452","article-title":"Autoantibodies in diabetes mellitus: current utility and perspectives","volume":"115","author":"Isermann","year":"2007","journal-title":"Exp Clin Endocrinol Diabetes"},{"key":"2026070713545126800_bib29","first-page":"336","article-title":"First-onset type 1 diabetes in an elderly woman with multiple islet-associated autoantibodies, and a literature review","volume":"44","author":"Tanaka","year":"2023","journal-title":"Neuro Endocrinol Lett"}],"container-title":["Endocrinology, Diabetes &amp; Metabolism Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/edm.bioscientifica.com\/view\/journals\/edm\/2026\/1\/EDM-25-0099.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/edm.bioscientifica.com\/downloadpdf\/journals\/edm\/2026\/1\/EDM-25-0099.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/journals.bioscientifica.com\/edm\/article-pdf\/doi\/10.1530\/EDM-25-0099\/505000\/edm-25-0099.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/journals.bioscientifica.com\/edm\/article-pdf\/doi\/10.1530\/EDM-25-0099\/505000\/edm-25-0099.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T17:55:02Z","timestamp":1783446902000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.bioscientifica.com\/edm\/article\/2026\/1\/EDM250099\/75415\/Acute-onset-type-1-diabetes-in-an-older-patient"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,1]]},"references-count":29,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,1,1]]}},"URL":"https:\/\/doi.org\/10.1530\/edm-25-0099","relation":{},"ISSN":["2052-0573"],"issn-type":[{"value":"2052-0573","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,1]]},"article-number":"EDM250099"}}