Hyperkalemia in Diabetic Ketoacidosis

L, Van Gaal; Leeuw, De

doi:10.2337/diacare.4.5.576

Cited by 7 publications

(2 citation statements)

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“…Acidosis, which causes potassium ions to leave the cells, as well as insulin deficiency and renal impairment, all contribute to hyperkalemia [8]. Potassium concentrations above 6.0 mmol/L have been reported in 22% to 32% cases at the time of presentation [9,10]. …”

Section: Discussionmentioning

confidence: 99%

Pseudoinfarction pattern in a patient with hyperkalemia, diabetic ketoacidosis and normal coronary vessels: a case report

2010

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IntroductionA rare electrocardiographic finding of hyperkalemia is ST segment elevation or the so called 'pseudoinfarction' pattern. It has been suggested that hyperkalemia causes the 'pseudoinfarction' pattern not only through its direct myocardial effects, but also through other mechanisms, such as anoxia, acidosis, and coronary artery spasm.Case presentationA 33-year-old Caucasian woman with insulin-treated diabetes presented with continuous epigastric pain of four hours duration. Her coronary heart disease risk factors apart from diabetes included hypercholesterolemia and smoking. Her initial electrocardiogram revealed ST segment elevation in the anteroseptal leads consistent with anterior myocardial infarction. Blood tests revealed hyperglycemia, hyperkalemia, metabolic acidosis and urine ketones, while a bed-side cardiac echocardiogram showed no segmental wall motion abnormality. We provisionally diagnosed diabetic ketoacidosis that was possibly precipitated by acute myocardial infarction, as there were findings in favor of (epigastric pain, electrocardiogram pattern, presence of 3 coronary heart disease risk factors) and against (young age, normal echocardiogram) the diagnosis of acute myocardial infarction. We performed cardiac angiography in order to exclude an anterior acute myocardial infarction, which could lead to myocardial damage and possible severe complications should there be a delay in treatment. Angiography revealed normal coronary arteries. During the procedure, ST segment elevation in the anteroseptal leads was still present in our patient's electrocardiogram results.ConclusionST segment elevation is a rare manifestation of hyperkalemia. In our patient, coronary spasm did not contribute to such an electrocardiography finding.

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Section: Discussionmentioning

confidence: 99%

Pseudoinfarction pattern in a patient with hyperkalemia, diabetic ketoacidosis and normal coronary vessels: a case report

2010

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“…Potassium concentrations above 6.0 mmol/l have been reported in 22%-32% cases at presentation. 3 4 Treatment with insulin and rising pH stimulate the entry of extracellular potassium into cells leading to a fall in extracellular concentrations.…”

Section: Discussionmentioning

confidence: 99%