Kazuhiro Kawahara, Nozomi Harai, Atsushi Sato, Yuya Suzuki, Takayasu Uchida, Kimio Matsumura, Kaoru Nagasawa, Shunya Goto, Shigeki Yamamoto, Tomoya Tanishima, Reiko Yasui, Norio Akuta, Yasumichi Mori
A woman in her 50s with alcohol-associated cirrhosis and pancreatic diabetes presented with disorientation, hypotension, coagulopathy, a plasma glucose level of 1,626 mg/dL, and severe lactic acidosis (lactate ＞30 mmol/L) after alcohol consumption and self-discontinuation of insulin. High-volume fluid resuscitation, vasopressors, continuous insulin infusion, and blood transfusion improved the metabolic derangements; however, she subsequently developed an inferior epigastric artery hemorrhage (IEAH), which required emergency transcatheter arterial embolization. IEAH can be fatal in critically ill patients with coagulopathy, necessitating prompt imaging and immediate life-saving treatment. Multidisciplinary comprehensive care is indispensable to ensure strict alcohol abstinence and thus prevent a relapse.