Markedly Elevated Troponin in Diabetic Ketoacidosis without Acute Coronary Syndrome

Abstract

Diabetic ketoacidosis (DKA) and myocardial infarction (MI), which are the leading coexisting causes of death in ketoacidosis, are both major medical emergencies. Troponin is the most valuable indicator of myocardial necrosis, but it is known that it may also elevate in a series of non-cardiac situations. DKA may imitate electrocardiogram (ECG) findings of MI (pseudoinfarction pattern). DK is a serious complication requiring emergent medical therapy. DKA may be the initial manifestation of type 1 diabetes mellitus (DM) or may result from increased insulin requirements in patients with type 1 DM during the course of infection, myocardial infarction, surgery or trauma. Mortality rate for DKA varies between 2% and 0% with age (1,2). MI is a well recognized precipitating cause and the leading coexisting cause of death in this entity. However, DKA may imitate some electrocardiographic findings similar to MI (pseudoinfarction pattern) (3). We aimed to present the case of a patient with DKA whose initial electrocardiography (ECG) showed ST segment depression in the lateral and inferior derivations and who had significant positive troponin values with no obstructive lesion in the coronary arteries.