ST-Segment Elevation and Normokalemia in Acute Diabetic Ketoacidosis: Case Report and Brief Literature Review

S Bryn Dhir,Abbas Husain

doi:10.5195/ijms.2020.432

Abstract

Background: Diabetic Ketoacidosis (DKA) is a life-threatening complication of Diabetes Mellitus Type 1 (DM1) and requires prompt management; however, benign transient electrocardiographic (ECG) abnormalities with normal serum potassium levels can be seen in diabetic patients secondary to metabolic changes. Understanding the varying presentation among patients provides valuable insight into the management of this seemingly uncommon and benign diagnosis. The Case: A 24-year-old male with a history of DM1 presented to the Emergency Department (ED) with ST-segment elevation, normal potassium levels and metabolic acidosis. The patient was found to be in DKA with benign cardiac manifestations. Conclusion: The correction of underlying metabolic abnormalities in DKA and the awareness of the benign cardiac pseudo pathology on ECG allows for effective management and personalized patient care.

Highlights

Patients with DM are at risk for life-threatening complications such as cerebral edema, noncardiogenic pulmonary edema, Diabetic Ketoacidosis (DKA), and a subset of complications secondary to metabolic imbalances
Recommendations for insulin therapy guided by serum potassium indicate that low-dose IV insulin should be used if the serum potassium is greater than or equal to 3.3 mEq/L, whereas therapy should be delayed if the level is less than 3.3 mEq/L in order to allow for potassium replacement.[1]
Despite the widely accepted and common practices of medical management for the disease, the diagnosis is often unrecognized or mistaken for another infection and the presentation of DKA vastly differs between patients

Summary

Introduction

Patients with DM are at risk for life-threatening complications such as cerebral edema, noncardiogenic pulmonary edema, DKA, and a subset of complications secondary to metabolic imbalances.

Results

Conclusion