Myocardial dysfunction associated with diabetic ketoacidosis in a 5-year-old girl

Halloum, Amjad; Neyadi, Shaikha Al

doi:10.1177/2050313x19847797

Cited by 7 publications

(4 citation statements)

References 15 publications

(14 reference statements)

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“…This is a novel case of severe DKA associated with mild myocardial dysfunction and disproportionately elevated NT-proBNP and troponin levels in a newly diagnosed T1D in an adolescent. As mentioned earlier, to the best of our knowledge, only three cases of myocardial injury have been observed in pediatric patients with severe new-onset DKA ( 5 , 6 , 7 ). In all of the above cases, patients experienced a fulminant clinical course of the disease with severe complications, while troponin levels were mildly elevated.…”

Section: Discussionmentioning

confidence: 83%

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Markedly elevated troponin and NT-proBNP and myocardial dysfunction in an adolescent with severe diabetic ketoacidosis: A case report

Sakou

Soldatou

Seretis

et al. 2022

Clin Pediatr Endocrinol

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. Severe diabetic ketoacidosis (DKA), rarely, may be associated with elevated troponin and proBNP levels in adults with a history of diabetes. However, few cases have reported this association in children with severe and complicated DKA. We describe a case of severe DKA (pH: 6.89, HCO3: 6.5) in a 14-yr-old female adolescent in which the symptoms of DKA were presented days before the diagnosis. The patient was under the effect of acidosis (Kussmaul respiration) for 12 h before admission to our hospital, where she was admitted in a critical clinical condition. After successful treatment with DKA with intensive intravenous fluid and regular insulin, the patient presented with abnormal cardiac rhythm, disturbance of interventricular septum motility, a mild decrease in left ventricular systolic function, negative T waves in leads III and aVF, and a marked increase in troponin and brain natriuretic peptide (NT-proBNP) levels. All abnormal findings completely resolved within 8 days after the initiation of DKA treatment. The phenomenon in our case was transient, and the patient had a good long-term outcome. However, it represents a challenge for clinicians; therefore, emphasis should be given to cardiac monitoring during the course of severe and prolonged DKA in children and adolescents.

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Section: Discussionmentioning

confidence: 83%

“…In addition, positive troponin levels during DKA in adults are associated with long-term adverse cardiac events ( 4 ). In children, only three reports have suggested an association between severe DKA and increased troponin levels ( 5 , 6 , 7 ).…”

Section: Introductionmentioning

confidence: 99%

Markedly elevated troponin and NT-proBNP and myocardial dysfunction in an adolescent with severe diabetic ketoacidosis: A case report

Sakou

Soldatou

Seretis

et al. 2022

Clin Pediatr Endocrinol

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“…Patient was subsequently moved from the medical ward to the cardiology ward and started on treatment for acute immune-mediated myocyte damage [3]. Myocarditis in adults with DKA is rarely reported however there are a few cases of myocarditis with DKA reported in children [4]. The aetiology proposed in children was that acidosis might affect the contractility of the cardiac muscle at the cellular level [4].…”

Section: Case Descriptionmentioning

confidence: 99%

“…Myocarditis in adults with DKA is rarely reported however there are a few cases of myocarditis with DKA reported in children [4]. The aetiology proposed in children was that acidosis might affect the contractility of the cardiac muscle at the cellular level [4].…”

Section: Case Descriptionmentioning

confidence: 99%

Myocarditis in a Patient with Diabetic Ketoacidosis: A Case Report

Saeed,

Gupta,

Javaid

2023

MJA

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A case of diabetic ketoacidosis (DKA) complicated by acute myocarditis, which was confirmed by Cardiac MRI. A 27-year-old man with diagnosed type 1 diabetes mellitus was hospitalized with severe DKA, blood sugar on admission was 69.3mmol/l and Hba1c was 104 mmol/mol. The initial ECG showed no acute changes however later he developed ST-T changes on his ECG associated with a significant troponin rise which raised the possibility of Myocarditis. The coronary angiogram ruled out any coronary artery disease, however the diagnosis of Myopericarditis was confirmed based on the echocardiogram findings and cardiac MRI. Viruses are the most common causative agents of myocarditis, our patient described symptoms of fatigue that might indicate the probable underlying viral infection however the excessive alcohol intake and non-compliance with insulin were the contributing factors towards development of diabetic ketoacidosis. The whole viral screen including parvovirus and covid-19 was negative. The Epstein bar virus (EBV) although weekly positive, withminimal viral load couldn't account for the patient's symptoms. Another rare condition that can present with myocarditis is fulminant type 1 diabetes mellitus, which is believed to be non-immune condition causing rapid onset of diabetes mellitus, the exact aetiology is still uncertain, but the presence of islet injury accompanied by myocardial inflammation points towards underlying viral infection as the cause of sudden onset of diabetes mellitus. The auto antibodies for Type 1 DM turn out to be negative in these cases, however in our patient they weren't done because he was a confirmed Type 1 Diabetic. The patient successfully responded to the symptomatic treatment for DKA, implicating that severe DKA was the cause of myocarditis. He was provided education on Type 1 diabetes mellitus and subsequently discharged without any further complications with future outpatient appointment in cardiology clinic.

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