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Looking at diabetic ketoacidosis through electrocardiogram window!
Soheila Talebi1, Farzaneh Ghobadi2, Arthur Cacacho1
1Medicine Department, Metropolitan Hospital, New York Medical College, New York, NY 10029.
The American Journal of Emergency Medicine
|November 19, 2015
Summary
Electrocardiography (ECG) can detect total body potassium (K+) deficiency in diabetic ketoacidosis (DKA) patients. Prolonged QTc intervals on ECG correlate with K+ depletion, aiding early hypokalemia diagnosis.
Area of Science:
- Cardiology
- Endocrinology
- Internal Medicine
Background:
- Initial serum potassium levels in diabetic ketoacidosis (DKA) do not accurately reflect total body potassium (K+) stores.
- Serum K+ is an unreliable predictor of subsequent hypokalemia in DKA patients.
Purpose of the Study:
- To test the hypothesis that total body K+ deficiency in DKA can be detected using surface electrocardiography (ECG).
Main Methods:
- Retrospective review of 350 DKA patient records.
- Collection of data on serial metabolic panels, blood gases, ketones, and K+ replacement.
- Comparison of biochemical findings between patients with and without corrected QT interval (QTUc) prolongation, excluding patients on medications affecting QTc.
Main Results:
- 61 patients were analyzed; 38 (62.9%) had QTUc ≥ 450 milliseconds.
- Patients with prolonged QTc received significantly more K+ supplementation and had lower serum K+ levels during hospitalization.
- No significant differences in initial serum K+, calcium, glucose, anion gap, acidosis, age, or heart rate were found between groups.
Conclusions:
- A significant relationship exists between K+ depletion and observed ECG changes in DKA.
- ECG is a reliable tool for the early diagnosis of hypokalemia in DKA patients.
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