Is the ST segment of diabetic ketoacidosis an acute coronary artery syndrome?

diabetesketoacidosis (DKA) is an acute complication of diabetes due to abnormal changes in electrolytes such as hyperketoneemia, hyperglycemia, metabolic acidosis, and hyperkalemiaTypical hyperkaleemia electrocardiogram (ECG) changes include features such as extended PR period, T-wave high-tip, widening of the time limit of QRS wave groups, and lower amplitudeIt is rare for hyperkalemia to cause ST segment elevation, especially in the case of DKA, although the exact causes of this pattern of injury may be manifold, and the causes and related knowledge are further understood through this casethe following cases, male, 19 years old, with "nausea, vomiting, abdominal pain for 1 day" to the hospital's emergency departmentPatients with nausea, back and full abdominal pain during the course of the disease, denied excessive urine, drinking more alcohol and recent weight lossThere is ahistory oftype 1 diabetesadmission to the hospital:body temperature of 37 degrees C, heart rate 126 times / minute, blood pressure 122/55 mmHg, breathing 40 times / minute, blood oxygen saturation 100%, full abdomen diffuse tenderness, no back-jumping or abdominal muscle tension, back diffuse tenderness, no severe deformity or trauma, the rest of the body did not see abnormallaboratory examination:blood gas analysis: pH7.09, bicarbonate 9.7 mmol/L, anion gap 27, blood potassium 5.7 mmol/l, glucose over 39 mmo/l, tropocaline can not detectElectrocardiogram: sinus tachycardia, V1 lead ST segment raised 3 mm, V2 conductor ST segment raised 5 mm (Figure 1)Establish an intravenous infusion channel (IV) to give the patient 1000mL lactic acid Ringer sodium injection, conventional insulin 0.1 U/kg/h drip Review eEOs after 30 minutes: V1, V2, V3 lead ST segment elevation (Figure 2) (Figure 1, V1, V2 guide ST segment elevation) (Figure 2, V1, V2, V2, V3 lead ST segment elevation) based on the dynamic changes of electrocardiogram, cardiology recommends coronary mediaothesis intervention, found that the coronary artery is normal, TIMI blood flow level 3, and no coronary artery mezzanine or vascular spasms and other signs The patient's electrocardiogram completely returned to normal after intervention (Figure 3), reviewed blood gas analysis: pH 7.09, glucose 34.3mmo/l, potassium 5.34 mmol/l, troponin I value 0.098, consistent with iv myocardial infarction The patient was discharged from the hospital after three days of treatment at the ICU (Figure 3, EED) discussion
st segment elevation is a known but rare phenomenon, a review found 19 such cases In all confirmed cases of hyperkalemia, the ST segment raised after corrected hyperkalemia and diabetic ketoacidosis will return to normal During the initial ST segment elevation, the average blood potassium is 7.47 mmo/l (standard deviation (SD) s 1.2) and the pH average is 7.05 (SD s 0.13) When the ST segment returns to normal, the average blood potassium is 4.88 mmol/L (SD - 0.89) and the pH averages 7.25 (SD s 0.23) In previous cases, however, the true value of interpreting the data as a whole was limited owing to incomplete data reporting Previous studies have suggested that changes in electrocardiograms are associated with blood potassium levels in patients The characteristics of this case vary, first, the patient's electrocardiogram returned to normal, but there was no significant improvement in blood potassium levels (5.7 mEq/L fell to 5.34 mEq/L, a decrease of 6.3%), although the average decrease in blood potassium in previous cases was 34.7% The error range for laboratory potassium was reported to be 0.1 mEq/L, indicating that this change in potassium is largely negligible Second, the rapid dynamic changes in the patient's electrocardiogram were not reported Previous case reports have discussed DKA-related metabolic acidosis as well as st.segment elevation However, the patient did not change significantly in pH, serum bicarbonate, or other serum electrolytes during eIPs In this case, the exact cause of ST segment elevation may be multi-factor, and further research is needed to better illustrate this phenomenon Since coronary artery stenosis or spasms were not found in coronary angiography, it is visible that ST segment elevation may be secondary to DKA-related metabolic disorders However, the authors suggest that small improvements in blood potassium levels in patients may lead to a return to normal st segments conclusions
Emergency physicians face some difficulties in the next diagnosis , one of which is to rule out myocardial infarction in DKA, where the electrocardiogram is dynamically evolving The above cases and related literature review highlighted the diagnostic confusion of DKA's metabolic disorders in simulating damage patterns at ECG Clinicians must recognize that myocardial infarction is a known cause of DKA, and that these two pathologies can coexist However, this case report and literature review confirm that DKA may be related to ECG performance similar to acute myocardial ischemia Emergency doctors should be aware of this phenomenon in order to try to distinguish it from ST-section elevated myocardial infarction Little Cute Source: The Voice of Medicine