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Cardio Diabetes Medicine 2017 255

Cardiac Complications in

Diabetic Ketoacidosis

Dr. Sankar, MD (Gen).,

Senior Assistant Professor, Department Of General Medicine,
Thoothukudi Medical College Hospital

ABSTRACT • Osmolality : 300 -320
Diabetic ketoacidosis (DKA) is a serious medical • Plasma ketones : ++++
emergency requiring hospitalisation. DKA consists of
the triad of hyperglycemia, ketosis and acidosis. Sev- • Sodium bicarbonate : <15 mEq/L
eral cardiovascular complications are associated with • Arterial pH : 6.8 - 7.3
ketoacidosis as a result of electrolyte imbalances in-
cluding arrhythmias ECG changes, ventricular tachy- • Arterial P CO2 : 20-30 mmHg
cardia and cardiac arrest which can be prevented • Anion gap [Na (Cl + HCO3)] : increased
by appropriate treatment. Cardiopulmonary compli- Clinical features / manifestations of DKA :
cations such as pulmonary oedema and respiratory
failure have also been seen with DKA.
SYMPTOMS
Acute myocardial infarction can predispose patients • Nausea / vomiting
with diabetes to ketoacidosis and worsen their car-
diovascular outcomes. • Thirst / polyuria
DKA is considered in individuals with type 1 or type • Abdominal pain
2 diabetes mellitus , severe hyperglycemia> 16.7 • Shortness of breath
mmol/L (300 mg/dL) and ketones are indicators
of DKA associated with symptoms such as nausea PHYSICAL FINDINGS
,vomiting or abdominal pain.
• Tachycardia
Blood measurement of beta hydroxy butyrate is pre- • Dehydration / hypotension
ferred over urine testing with nitroprusside based as-
says that measures only acetoacetate and acetone. • Tachypnoea
DKA was formerly considered as a hallmark of type • Kussmaul respiration
1 DM but also occurs in individuals who lack immu- • Respiratory distress
nologic features of type 1 DM (type 2 DM).
• Abdominal tenderness
DKA is associated with absolute or relative insulin • Lethargy / obtundation
deficiency, volume depletion and acid base abnor- • Cerebral oedema / possibly coma
malities.
Precipitating events :
Laboratory values of DKA :
• Inadequate insulin administration
• Glucose : 13.9 - 33.3 mmol/L 0R 250 -600
mgs/dl • Infection (pneumonia / UTI / gastroenteritis/sep-
sis)
• Sodium : 125 -135mEq/L
• Infarction(cerebral/coronary / mesenteric/periph-
• Potassium : normal to increased
eral)

Cardio Diabetes Medicine