E. Aksakal, H. Duman, T. Ulus and E. Bayram (2009). Acute inferior pseudoinfarction pattern in a patient with normokalemia and diabetic ketoacidosis. The American journal of emergency medicine, 27(2), 251.e3-5. https://doi.org/10.1016/j.ajem.2008.06.024

PubMed 19371549

[Abstract]
Diabetic ketoacidosis (DKA) is an important medical emergency and may cause electrocardiogram (ECG) changes mimicking myocardial infarction. In the literature, hyperkalemia-associated ST-segment elevations have been defined in DKA; it has been demonstrated that these changes resolve completely after the treatment of hyperkalemia. We aimed to present a case with DKA in whom ST-segment elevation in inferior derivations was observed, but serum potassium level (4.4 mEq/L) was normal. The patient was admitted to the emergency department with complaints of nausea, bloody vomiting, and epigastric pain. Intravenous 0.9% saline, soluble insulin, and proton pump inhibitor were begun. Because of bloody vomiting, antiaggregant and anticoagulant therapy was not administered and coronary angiography was not considered at the beginning. Two hours after the beginning of the treatment, the blood glucose level dramatically decreased (from 712 to 263 mg/dL), and the metabolic acidosis view in arterial blood gas sample was improved. The repeated ECG depicted complete ST segment resolution. Transthoracic echocardiogram determined normal ventricular wall motion. Cardiac biomarkers remained in normal limits in the follow-up period. Coronary angiography performed 3 days after hospital admission was evaluated as normal. The patient recovered uneventfully, and gastrointestinal tract bleeding did not repeat. The ECG was repeated, and ST segments in izoelectric line were observed.