We describe a case of delayed presentation of ST-segment elevation myocardial infarction (STEMI) complicated by ventricular thrombus and peripheral embolization causing limb ischemia. Our patient initially presented with symptoms of acute limb ischemia. However, on preoperative evaluation, STEMI was diagnosed. He required emergent revascularization of the left anterior descending artery followed by thrombectomy of the femoral artery. The cause of the limb ischemia was deemed to be a late presenting STEMI that was complicated by left ventricular thrombus, hence causing lower extremity embolization. Delayed presentations and complications related to STEMI may manifest as acute limb ischemia in the setting of ventricular thrombus formation and subsequent distal embolization.
Diabetic ketoacidosis (DKA) is a common complication in patients with type I and ketosisprone type II diabetes mellitus. A variety of electrolyte derangements are encountered during the presentation and management of DKA. Hypercalcemia has been rarely reported in DKA, particularly when patients develop severe acidosis. However, we describe a patient with DKA and severe hypercalcemia in the absence of severe acidosis. The hypercalcemia quickly corrected back to normal with the treatment of DKA.
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