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

Wray, Jesse; Yoo, Michael J.; Bridwell, Rachel E.; Tannenbaum, Lloyd; Henderson, Jonathan

doi:10.7759/cureus.7409

Cited by 5 publications

(6 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…1 With respect to the present case, acute myocardial infarction-like ST-segment elevation is also known to occur in diabetic ketoacidosis, nearly universally in the setting of coexisting hyperkalemia. 2 A review of 19 previously published cases of ST-segment elevation associated with diabetic ketoacidosis documented an initial potassium level of 7.0 mEq/L or greater in 74% and pH level of 7.23 or lower in all. 1 Only 1 of the 19 patients had a normal potassium level (potassium, 4.4 mEq/L; pH, 7.15).…”

Section: Discussionmentioning

confidence: 99%

“…In both hyperkalemia and Brugada syndrome, ST-segment elevation is generally limited to leads V 1 to V 3 , typically with a downsloping (coved) shape . With respect to the present case, acute myocardial infarction–like ST-segment elevation is also known to occur in diabetic ketoacidosis, nearly universally in the setting of coexisting hyperkalemia . A review of 19 previously published cases of ST-segment elevation associated with diabetic ketoacidosis documented an initial potassium level of 7.0 mEq/L or greater in 74% and pH level of 7.23 or lower in all .…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Acute Inferior Myocardial Infarction or Not?

2022

View full text Add to dashboard Cite

A patient in their 50s presented to the emergency department with a 3-day history of confusion and falls. The patient had type 2 diabetes treated with empagliflozin, 25 mg daily; metformin, 1000 mg twice daily; and glipizide, 5 mg daily. Initial evaluation revealed a heart rate of 102 beats/min, blood pressure of 143/98 mm Hg, oxygen saturation of 100%, temperature of 36.6 °C, and confusion. A 12-lead electrocardiogram (ECG) was obtained in the emergency department (Figure , A).Questions: What are the notable findings on the patient's initial ECG? What conditions can cause these ECG abnormalities?

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Acute Inferior Myocardial Infarction or Not?

2022

View full text Add to dashboard Cite

show abstract

“…With less than a handful of cases of severe hyperkalemia in DKA being observed, this scenario is uncommon. 4 – 8 And the occurrence of cardiac arrest, to the best of our knowledge, has not been reported yet. Patients should be well educated regarding consequences of skipping their antidiabetic medications.…”

mentioning

confidence: 92%

Hyperkalemic Cardiac Arrest in a Patient with Diabetic Ketoacidosis

Nambiar¹

2020

Indian Journal of Critical Care Medicine

View full text Add to dashboard Cite

A bstract Aim To highlight the occurrence of cardiac arrest due to hyperkalemia in diabetic ketoacidosis (DKA). Background Diabetic ketoacidosis is a commonly encountered condition. These patients can have normal or mildly elevated levels of potassium. Our patient had severe hyperkalemia due to DKA resulting in cardiac arrest. Her high potassium diet and use of angiotensin receptor blocker along with acute kidney injury (AKI) would have also contributed to hyperkalemia. Case description A 58-year-old female, known case of diabetes mellitus on insulin therapy and hypertension on telmisartan, presented with nausea, vomiting, and abdominal pain. She was diagnosed to have DKA with AKI precipitated by missed insulin and urinary tract infection. She was also on high potassium diet. Her electrocardiogram showed sinus bradycardia with prolonged QRS interval. Her potassium levels were elevated. She soon went into asystole and cardiac arrest and was resuscitated. Diabetic ketoacidosis protocols were followed along with antibiotics, and the patient improved. Conclusion Severe hyperkalemia in DKA is uncommon, and this hyperkalemia resulting in cardiac arrest is an unreported scenario. Potassium correction along with DKA management protocol forms the mainstay of treatment. Clinical significance Mild to moderate elevation in serum potassium occurs frequently in DKA. However, severe hyperkalemia is uncommon and is likely to be the result of insulin deficiency, acidosis, hyperosmolality, severe dehydration, and renal potassium retention. Such elevated level of potassium requires urgent correction in order to prevent cardiac arrest. How to cite this article Manappallil RG, Nambiar J. Hyperkalemic Cardiac Arrest in a Patient with Diabetic Ketoacidosis. Indian J Crit Care Med 2020;24(8):737–738.

show abstract

“…[2][3][4] Occasionally, patients with hyperkalemia could also present with ST elevation on their ECG recording. [5][6][7][8][9] Most commonly, the ST elevation in hyperkalemia has a down-sloping characteristic, however, it could also rarely be identical to that of acute myocardial infarction (MI) which has a plateau or upsloping pattern. 4 Hence, even when it is infrequent, this finding is very important as it could mislead our diagnosis and treatment and subsequently subject the patients to the risk of unnecessary intervention.…”

mentioning

confidence: 99%

Hyperkalemia Mimicking Anteroseptal Myocardial Infarction

Nugraha,

Husen,

Muliawan

et al. 2023

IJC

View full text Add to dashboard Cite

Background: Hyperkalemia often results in cardiac emergency associated with fatal cardiac arrhythmias. However, the presence of ST segment elevation in hyperkalemia is rare and could potentially subject the patients to unnecessary risk of intervention. Most commonly, ST elevation in hyperkalemia presents in a down-sloping fashion compared to the typical convex or upsloping pattern in myocardial infarction. However, in some cases, the ST elevation morphology can be very identical and difficult to distinguish. Herein, we describe a hyperkalemic patient presenting with non-ischemic ST segment elevation that resolved spontaneously following therapy. Case illustration: A 77-year-old, bed-ridden, inarticulate woman was admitted to emergency department with acute dyspnea perceived for 1.5 hours. The patient’s past clinical history included craniotomy for subdural hematoma, poorly controlled hypertension, hypertensive heart disease, rheumatoid arthritis, and dementia and was under candesartan, amlodipine, nebivolol, spironolactone, and atorvastatin treatment. The 12-lead electrocardiography (ECG) recording showed wide QRS complex with left bundle branch block pattern, slow atrial fibrillation with total atrioventricular block, ST segment elevation and Q wave in anteroseptal leads, and peaked T wave (Figure 1A). The pattern of ST elevation was indistinguishable from that of myocardial infarction which necessitated further laboratory confirmation. Laboratory results showed severe hyperkalemia (K+ 7.93 mmol/L) and normal troponin level (45.0 ng/L). The patient was given serial insulin-based therapy and calcium gluconate immediately. The follow-up ECG pictured normal sinus rhythm with no sign of bundle branch block, resolution of ST segment elevation, and reduction in T wave amplitude (Figure 1B). However, the reduction in potassium level was not significant and the patient also experienced an acute kidney injury. The patient was transferred to intensive care unit and was prepared for hemodialysis. Conclusion: ST segment elevation is a rare feature of hyperkalemia that could mislead the patient’s treatment. Thorough ECG evaluation is the key to narrow down the differential diagnosis. Every deviant feature should not be interpreted separately. Laboratory tests could help confirm the diagnosis, particularly in patients with atypical presentation and could help avoid unnecessary risk of intervention.

show abstract

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

Cited by 5 publications

References 17 publications

Acute Inferior Myocardial Infarction or Not?

Acute Inferior Myocardial Infarction or Not?

Hyperkalemic Cardiac Arrest in a Patient with Diabetic Ketoacidosis

Hyperkalemia Mimicking Anteroseptal Myocardial Infarction

Contact Info

Product

Resources

About