ST-Segment Elevation and Normokalemia in Acute Diabetic Ketoacidosis: Case Report and Brief Literature Review

Authors

DOI:

https://doi.org/10.5195/ijms.2020.432

Keywords:

Diabetic ketoacidosis, Diabetes mellitus type 1, Myocardial infarction, Pseudo pericarditis, Normokalemia

Abstract

Background: Diabetic Ketoacidosis (DKA) is a life-threatening complication of Diabetes Mellitus Type 1 (DM1) and requires prompt management; however, benign transient electrocardiographic (ECG) abnormalities with normal serum potassium levels can be seen in diabetic patients secondary to metabolic changes. Understanding the varying presentation among patients provides valuable insight into the management of this seemingly uncommon and benign diagnosis.

The Case: A 24-year-old male with a history of DM1 presented to the Emergency Department (ED) with ST-segment elevation, normal potassium levels and metabolic acidosis. The patient was found to be in DKA with benign cardiac manifestations.

Conclusion: The correction of underlying metabolic abnormalities in DKA and the awareness of the benign cardiac pseudo pathology on ECG allows for effective management and personalized patient care.

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Author Biographies

S. Bryn Dhir, International American University College of Medicine

Bryn Dhir, Honors BA, is a fourth year medical student interested in emergency medicine, international medical care, rural wilderness medicine and disaster management.  She is the recipient of the medical student awards for excellence in emergency medicine from the Society for Academic Emergency Medicine, and the American College of Emergency Physicians. Her research interests are in medical imaging, neuroscience, proteomics, climate change, and scienctific research in the Arctic and Antarctica and has a keen interest in medical education and leadership skill development for youth.

Abbas Husain, Emergency Department, Staten Island University Hospital

Abbas Husain, MD, FACEP is an emergency medicine physician who trained at Drexel University College of Medicine, Philadelphia, PA. He is an Associate Program Director for the Emergency Medicine Residency Program at Staten Island University Hospital, New York and the President of the ALL NYC EM.  His academic interests include international medicine and integration of technology in medicine. Along with his strong support of FOAMed, he has a keen interest in clinical informatics and medical education. He is the editor-in-chief of Staten Island Emergency Medicine website and serves on the board for the New York American College of Emergency Physicians.

 

References

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Perilli G, Saraceni C, Daniels MN, Ahmad A. Diabetic Ketoacidosis: A Review and Update. Curr Emerg Hosp Med Rep. 2013 Dec 22;1:10-17.

Chava NR. ECG in Diabetic Ketoacidosis. Arch Intern Med. 1984 Dec;144(12):2379–2380.

Stewart JS. Management of cardiac arrest with special reference to metabolic acidosis. Br Med J. 1964 Feb 22;1(5381):476–479.

Campbell LW, Duncan LJ, Clarke BF. Pericarditis in diabetic ketoacidosis. Br Heart J. 1977 Jan;39(1):110-112.

Armanino LP, Ory EM. Acute pleurisy as a dehydration phenomenon in diabetic precoma. Am J Med Sci. 1946 May;211:597-601.

Bennett KR, Blake TM. (1971). Pseudopericarditis in diabetic ketoacidosis. South Med J. 1971 May;64(5):610-2.

Aksakal E, Ulus T, Bayram, Bayram E, Duman H. Acute inferior pseudoinfarction pattern in a patient with normokalemia and diabetic ketoacidosis. Am J Emerg Med. 2009 Jan 1;27(2):251-251.

Kale T, Agrawal H, Pandit R, Naheed Z. T Wave investigation in diabetic ketoacidosis with normokalemia in an adolescent. Pediatr Cardiol. 2013 August;34(6):1508.

Fronczyk A, Moleda P, Majkowska L. Clinical and ECG patterns of pseudoinfarction in a young man with type 1 diabetes, diabetic ketoacidosis and normokalaemia. Clin Dibet. 2016 July;5(2):73-76.

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Published

2020-04-30

How to Cite

Dhir, S. B., & Husain, A. (2020). ST-Segment Elevation and Normokalemia in Acute Diabetic Ketoacidosis: Case Report and Brief Literature Review. International Journal of Medical Students, 8(1), 33–35. https://doi.org/10.5195/ijms.2020.432

Issue

Vol. 8 No. 1 (2020)

Section

Case Report

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