Carrizales-Sepúlveda Edgar Francisco, Del Cueto-Aguilera Ángel Noé, Jiménez-Castillo Raúl Alberto, de la Cruz-Mata Olga Norali, Fikir-Ordoñez Mariana, Vera-Pineda Raymundo, Hernández-Guajardo Dalí Alejandro, Ordaz-Farías Alejandro, Flores-Ramírez Ramiro
Internal Medicine Department, Hospital Universitario, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico.
Echocardiography Laboratory, Cardiology Service, Hospital Universitario, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico.
Case Rep Cardiol. 2019 Mar 31;2019:4063670. doi: 10.1155/2019/4063670. eCollection 2019.
A 48-year-old male with a prior diagnosis of diabetes mellitus presented to the emergency department with malaise and nausea. On work-up, he was found with hyperglycemia and high anion gap metabolic acidosis, with a blood pH < 6.94. A diagnosis of severe diabetic ketoacidosis was established; serum electrolyte analysis showed mild hyperkalemia. On work-up, a 12-lead electrocardiogram was obtained, and it showed an ST-segment elevation on anterior leads that completely resolved with diabetic ketoacidosis treatment. ST-segment elevation myocardial infarction can be a precipitant factor for diabetic ketoacidosis, and evaluation of diabetic patients with suspected myocardial infarction can be challenging since they can present with atypical or little symptoms. Hyperkalemia, which usually accompanies diabetic ketoacidosis, can cause electrocardiographic alterations that are well described, but ST-segment elevation is uncommon. A pseudomyocardial infarction pattern has been described in patients with diabetic ketoacidosis; of note, most of these patients presented severe hyperkalemia. We believe this is of great importance for clinicians because they must be able to recognize those patients that present with electrocardiographic abnormalities secondary to the metabolic alterations and those that can be experiencing actual ongoing ischemia, in order to establish an appropriate and prompt treatment.
一名先前被诊断为糖尿病的48岁男性因不适和恶心前往急诊科就诊。检查发现他患有高血糖和高阴离子间隙代谢性酸中毒，血液pH值<6.94。确诊为严重糖尿病酮症酸中毒；血清电解质分析显示轻度高钾血症。检查时进行了12导联心电图检查，结果显示前壁导联ST段抬高，经糖尿病酮症酸中毒治疗后完全缓解。ST段抬高型心肌梗死可能是糖尿病酮症酸中毒的诱发因素，对疑似心肌梗死的糖尿病患者进行评估具有挑战性，因为他们可能表现出非典型症状或症状轻微。通常伴随糖尿病酮症酸中毒的高钾血症可导致已被充分描述的心电图改变，但ST段抬高并不常见。糖尿病酮症酸中毒患者中曾描述过假性心肌梗死模式；值得注意的是，这些患者大多出现严重高钾血症。我们认为这对临床医生非常重要，因为他们必须能够识别那些因代谢改变而出现心电图异常的患者以及那些可能正在经历实际持续性缺血的患者，以便制定适当且及时的治疗方案。
