INCREASED P WAVE DISPERSION IN PATIENTS WITH DIABETIC KETOACIDOSIS

Abstract

Introduction: Diabetic ketoacidosis (DKA) is the most common hyperglycemic emergency in patients with diabetes mellitus (DM). Further, atrial fibrillation (AF) incidence is higher in diabetic patients. P wave dispersion (PWD) is a non-invasive electrocardiographic parameter and increases in patients with atrial arrhythmias such as AF. The aim of this study was to examine the effect of DKA on PWD. Methods: Fifty-three type 2 DM patients with DKA were included in the study. All patients had sinus rhythm and laboratory parameters such as blood glucose, urinary ketones, electrolytes, urea, creatinine, arterial blood gas were measured. We performed the standard 12-lead electrocardiogram to all patients and PWD was calculated as the difference between the longest and shortest P wave duration (PWD=Pmax-Pmin). Pmax, Pmin and PWD were measured during ketoacidosis and reevaluated at least six hours later from urinary ketone being negative. Results: The majority of the patients were female (F/M: 37/16) and the mean age was 53.1±15.0 years. The mean plasma glucose level was 400.6±119.1 mg/dL. We detected that PWD and Pmax during ketoacidosis was higher than six hours later from urinary ketone being negative [60 (40-100) ms; 40 (20-60) ms, (p<0.001) and 110 (100-140) ms; 80 (80-120) ms, (p<0.001) respectively]. There was no significant relationship between PWD and Pmax with regard to any biochemical and demographic data. Conclusion: The results showed that PWD, which is a predictor factor for atrial artyhythmias, is increased during ketoacidosis and decreased after treatment of ketoacidosis. Therefore, we suggest that these patients should be monitored during ketoacidosis treatment for following up arrhythmias.