Hyperkalemia-Induced Coronary Artery Spasm and Junctional Tachycardia in Diabetic Ketoacidosis Reversed with Insulin and Saline, A Case Report

Yasser Mohammed Hassanain Elsayed

doi:10.32474/gjapm.2020.02.000149

Abstract

The admission serum potassium concentration is usually elevated in patients with diabetic ketoacidosis (DKA)

Highlights

The admission serum potassium concentration is usually elevated in patients with diabetic ketoacidosis (DKA) [1]
ECG tracing on discharge was showed the disappearance of junctional tachycardia with normalization of the above ST-segment depressions and wavy ECG sign of hypocalcemia (Figure 2)
Overview: A 32-year-old single Egyptian male patient presented with diabetic ketoacidosis, junctional tachycardia, and coronary artery spasm in the presence of marked hyperkalemia

Summary

Introduction

The admission serum potassium concentration is usually elevated in patients with diabetic ketoacidosis (DKA) [1]. The mean serum potassium in patients with DKA was 5.6 mEq/l, respectively These high levels occur because of a shift of potassium from the intracellular to the extracellular space due to acidemia, insulin deficiency, and hypertonicity [1]. To prevent hypokalemia, most patients require intravenous potassium during DKA therapy This increases the risk of dangerous irregularities in the heart rate. The patient initially treated with act-rapid insulin (initial 8 units IVB), normal saline 0.9% (1000 ml IVB in the first hour), hourly vital signs monitoring, hourly blood glucose measurement, and hourly urinary acetone check-up. ECG tracing on discharge was showed the disappearance of junctional tachycardia with normalization of the above ST-segment depressions and wavy ECG sign of hypocalcemia (Figure 2). The patient discharged after stability on the fourth day of admission

Discussion

Findings

Conclusion