Rationale: Serum potassium concentration is usually elevated in the cases of diabetic ketoacidosis. Coronary artery spasm is recognized after the hematological chemical disturbance. Hyperkalemia is a rare cause of junctional tachycardia. Insulin decreases potassium levels in the blood by redistributing it into cells via increased sodium-potassium pump activity.
Patient concerns:A young housewife female patient presented to the emergency department with diabetic ketoacidosis, coronary artery spasm, and junctional tachycardia.Diagnosis: Hyperkalemia-induced coronary artery spasm and junctional tachycardia in diabetic ketoacidosis.
Interventions:Electrocardiography, oxygenation, central venous pressure monitoring, and echocardiography.Lessons: Electrolytes disturbance especially hyperkalemia is a significant serious metabolic problem in ketoacidosis. Hyperkalemia is a possible cause for both coronary artery spasm and junctional tachycardia in diabetic ketoacidosis.Outcomes: Successful reversal of ketotic hyperkalemia-induced coronary artery spasm and junctional tachycardia with insulin and saline.
Rationale: Electrocardiographic is a fundamental tool for a cardiologist, critical care physician, and emergency medicine specialist. The electrolyte imbalance is a very important entity in clinical medicine management. Camel-hump T-wave and the Tee-Pee sign, recently; Wavy triple and Wavy double signs of hypocalcemia (Yasser's sign) are electrocardiographic findings linked to electrolyte deficiencies. Patient concerns: A middle-aged male car-painter patient presented to the emergency department with atypical severe twisting chest pain, hypocalcemia, hypokalemia, and hypernatremia. Diagnosis: Hypocalcemia-induced Camel-hump T-wave, Tee Pee sign, Wavy double sign of hypocalcemia (Yasser's sign), and bradycardia in a car-painter. Interventions: Electrocardiography, arterial blood gases, oxygenation, and echocardiography. Lessons: The dramatic reversal of Camel-hump T-Wave, Tee-Pee sign, Wavy double sign ofhypocalcemia (Yasser's sign) after calcium gluconate injection interpret that these signs were due to hypocalcemia. The twisting chest pain and its limited disappearance immediately after calcium gluconate injection indicate the pain can be named as "chest tetany". Non-atropine bradycardia response is evidence that the management of the cause of bradycardia sometimes is essential e.g. hypocalcemia in the current case. Outcomes: There was a dramatic response of both clinical and electrocardiography including Camel-hump T-wave, Tee Pee sign, the wavy double sign of hypocalcemia, and bradycardia.
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