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Rationale: Serum potassium concentration is usually elevated in the cases of diabetic ketoacidosis. Coronary artery spasm is recognized after the hematological chemical disturbance. Hyperkalemia is a rare cause of junctional tachycardia. Insulin decreases potassium levels in the blood by redistributing it into cells via increased sodium-potassium pump activity. Patient concerns:A young housewife female patient presented to the emergency department with diabetic ketoacidosis, coronary artery spasm, and junctional tachycardia.Diagnosis: Hyperkalemia-induced coronary artery spasm and junctional tachycardia in diabetic ketoacidosis. Interventions:Electrocardiography, oxygenation, central venous pressure monitoring, and echocardiography.Lessons: Electrolytes disturbance especially hyperkalemia is a significant serious metabolic problem in ketoacidosis. Hyperkalemia is a possible cause for both coronary artery spasm and junctional tachycardia in diabetic ketoacidosis.Outcomes: Successful reversal of ketotic hyperkalemia-induced coronary artery spasm and junctional tachycardia with insulin and saline.

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