Pseudo-Myocardial Infarction in Diabetic Ketoacidosis with Hyperkalemia

Bellazzini, Marc A.; Meyer, Tom

doi:10.1016/j.jemermed.2007.04.024

Cited by 20 publications

(20 citation statements)

References 16 publications

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“…A recent study reported ST segment elevation in a high proportion of neonatal diarrheic calves with hyperkalemia, which was also commonly seen in calves of the present study (Table , Figure C‐H). ST segment elevation was also described as a rare manifestation of hyperkalemia in humans (most frequently in patients with diabetic ketoacidosis) where the ECG findings can resemble acute myocardial infarction and have therefore been described as pseudoinfarct or pseudoinjury ECG pattern . The mechanisms for hyperkalemia associated ST segment elevation in humans are not well understood, but repolarization abnormalities and other concurrent metabolic abnormalities such as acidosis have been discussed …”

Section: Discussionmentioning

confidence: 99%

“…ST segment elevation was also described as a rare manifestation of hyperkalemia in humans (most frequently in patients with diabetic ketoacidosis) where the ECG findings can resemble acute myocardial infarction and have therefore been described as pseudoinfarct or pseudoinjury ECG pattern. 60,61 The mechanisms for hyperkalemia associated ST segment elevation in humans are not well understood, but repolarization abnormalities and other concurrent metabolic abnormalities such as acidosis have been discussed. 62 Although typical ECG abnormalities were seen in hyperkalemic calves of our study population, bradycardia, or bradyarrhythmia was a rare finding in calves with increases in cK 1 .…”

Section: Thismentioning

confidence: 99%

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Electrocardiographic findings in 130 hospitalized neonatal calves with diarrhea and associated potassium balance disorders

Trefz

Lorenz

Constable

2018

Veterinary Internal Medicne

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BackgroundHyperkalemia in neonatal diarrheic calves can potentially result in serious cardiac conduction abnormalities and arrhythmias.ObjectivesTo document electrocardiographic (ECG) findings and the sequence of ECG changes that are associated with increasing plasma potassium concentrations (cK+) in a large population of neonatal diarrheic calves.AnimalsOne hundred and thirty neonatal diarrheic calves (age ≤21 days).MethodsProspective observational study involving calves admitted to a veterinary teaching hospital.ResultsHyperkalemic calves (cK+: 5.8‐10.2, blood pH: 6.55‐7.47) had significantly (P < .05) longer QRS durations as well as deeper S wave, higher T wave, and higher ST segment amplitudes in lead II than calves, which had both venous blood pH and cK+ within the reference range. The first ECG changes in response to an increase in cK+ were an increase in voltages of P, Ta, S, and T wave amplitudes. Segmented linear regression indicated that P wave amplitude decreased when cK+ >6.5 mmol/L, S wave amplitude voltage decreased when cK+ >7.4 mmol/L, QRS duration increased when cK+ >7.8 mmol/L, J point amplitude increased when cK+ >7.9 mmol/L, and ST segment angle increased when cK+ >9.1 mmol/L. P wave amplitude was characterized by a second common break point at cK+ = 8.2 mmol/L, above which value the amplitude was 0.Conclusions and Clinical ImportanceHyperkalemia in neonatal diarrheic calves is associated with serious cardiac conduction abnormalities. In addition to increased S and T wave amplitude voltages, alterations of P and Ta wave amplitudes are early signs of hyperkalemia, which is consistent with the known sensitivity of atrial myocytes to increased cK+.

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Section: Discussionmentioning

confidence: 99%

Section: Thismentioning

confidence: 99%

Electrocardiographic findings in 130 hospitalized neonatal calves with diarrhea and associated potassium balance disorders

Trefz

Lorenz

Constable

2018

Veterinary Internal Medicne

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“…interpreting this data as a whole is limited given incomplete reporting of data in prior cases. Many of these reports theorize that the resolution of these ECG findings correlated with significant corrections in patient potassium levels [3,[6][7][8][10][11]. This specific case demonstrated normalization of the patient's ECG with clinically insignificant improvement in serum potassium levels.…”

Section: Figure 1: Initial Electrocardiogram Obtained Upon Arrival Tomentioning

confidence: 77%

ST-Segment Elevation in the Setting of Diabetic Ketoacidosis: Is It Acute Coronary Syndrome?

Wray

Yoo

Bridwell

et al. 2020

Cureus

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Diabetic ketoacidosis (DKA) with resulting hyperkalemia can lead to ST-segment elevations on electrocardiogram (ECG). Previous publications theorize that significant improvements in patient potassium levels lead to the resolution of this rare phenomenon, also known as "pseudo-infarct" pattern. The authors provide a unique case along with a literature review of DKA-associated ST-segment elevations. This specific case distinctively demonstrates the resolution of the pseudo-infarct pattern in the setting of minor improvements in serum potassium and continued acidosis.

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“…Precipitating factors must be diagnosed and treated (1,31,32). • ECG changes may reflect hyperkalemia (78,79) • A small increase in troponin may occur without overt ischemia (80) • Thyrotoxicosis (81) • Trauma • Drugs…”

Section: Managementmentioning

confidence: 99%

Hyperglycemic Emergencies in Adults

Goguen¹,

Gilbert²

2018

Canadian Journal of Diabetes

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KEY MESSAGES • Diabetic ketoacidosis and hyperosmolar hyperglycemic state should be suspected in people who have diabetes and are ill. If either diabetic ketoacidosis or hyperosmolar hyperglycemic state is diagnosed, precipitating factors must be sought and treated. • Diabetic ketoacidosis and hyperosmolar hyperglycemic state are medical emergencies that require treatment and monitoring for multiple metabolic abnormalities and vigilance for complications. • A normal or mildly elevated blood glucose level does not rule out diabetic ketoacidosis in certain conditions, such as pregnancy or with SGLT2 inhibitor use. • Diabetic ketoacidosis requires intravenous insulin administration (0.1 units/ kg/h) for resolution. Bicarbonate therapy may be considered only for extreme acidosis (pH ≤7.0). KEY MESSAGES FOR PEOPLE WITH DIABETES When you are sick, your blood glucose levels may fluctuate and be unpredictable: • During these times, it is a good idea to check your blood glucose levels more often than usual (for example, every 2 to 4 hours). • Drink plenty of sugar-free fluids or water. • If you have type 1 diabetes with blood glucose levels remaining over 14 mmol/L before meals, or if you have symptoms of diabetic ketoacidosis (see Table 1), check for ketones by performing a urine ketone test or blood ketone test. Blood ketone testing is preferred over urine testing. • Develop a sick-day plan with your diabetes health-care team. This should include information on: • Which diabetes medications you should continue and which ones you should temporarily stop • Guidelines for insulin adjustment if you are on insulin • Advice on when to contact your health-care provider or go to the emergency room. Note: Although the diagnosis and treatment of diabetic ketoacidosis (DKA) in adults and in children share general principles, there are significant differences in their application, largely related to the increased risk of lifethreatening cerebral edema with DKA in children and adolescents. The specific issues related to treatment of DKA in children and adolescents are addressed in the Type 1 Diabetes in Children and Adolescents chapter, p. S234. Symptoms Signs Hyperglycemia Polyuria, polydipsia, weakness ECFV contraction Acidosis Air hunger, nausea, vomiting and abdominal pain Altered sensorium Kussmaul respiration, acetone-odoured breath Altered sensorium Precipitating condition See list of conditions in Table 2 Can J Diabetes 42 (2018) S109-S114 Contents lists available at ScienceDirect Canadian Journal of Diabetes j o u r n a l h o m e p a g e : w w w. c a n a d i a n j o u r n a l o f d i a b e t e s. c o m

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Pseudo-Myocardial Infarction in Diabetic Ketoacidosis with Hyperkalemia

Cited by 20 publications

References 16 publications

Electrocardiographic findings in 130 hospitalized neonatal calves with diarrhea and associated potassium balance disorders

Electrocardiographic findings in 130 hospitalized neonatal calves with diarrhea and associated potassium balance disorders

ST-Segment Elevation in the Setting of Diabetic Ketoacidosis: Is It Acute Coronary Syndrome?

Hyperglycemic Emergencies in Adults

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