Hypoglycaemia-induced ischaemic ECG changes.

A patient with an 8 year history of insulin-dependent diabetes mellitus was admitted to the emergency ward for hypoglycaemic coma (blood glucose 1.11 mmol/l). The initial electrocardiogram revealed a junctional rhythm and major ischaemia with an ST depression of 6-7 mm. Sinus rhythm and normal repolarization were recovered 15 minutes after administration of 50% glucose. No evidence of myocardial infarction appeared during follow-up. Such hypoglycaemia-induced ECG changes have rarely been documented and no conclusive explanation has been put forward although altered balance between energy supply and demand in myocardial tissue has been suggested. Special care should be taken when administering hypoglycaemic agents to patients at risk for myocardial ischaemia.