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Manappallil RG, Nambiar J. Hyperkalemic Cardiac Arrest in a Patient with Diabetic Ketoacidosis. Indian J Crit Care Med. 2020;24(8):737-738doi: 10.5005/jp-journals-10071-23526.
Manappallil, R. G., & Nambiar, J. (2020). Hyperkalemic Cardiac Arrest in a Patient with Diabetic Ketoacidosis. Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine, 24(8), 737-738. https://doi.org/10.5005/jp-journals-10071-23526
Manappallil, Robin G, and Nambiar, Jayasree. "Hyperkalemic Cardiac Arrest in a Patient with Diabetic Ketoacidosis." Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine vol. 24,8 (2020): 737-738. doi: https://doi.org/10.5005/jp-journals-10071-23526
Manappallil RG, Nambiar J. Hyperkalemic Cardiac Arrest in a Patient with Diabetic Ketoacidosis. Indian J Crit Care Med. 2020 Aug;24(8):737-738. doi: 10.5005/jp-journals-10071-23526. PMID: 33024389; PMCID: PMC7519603.
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Indian J Crit Care Med. 2020 Aug;24(8):737-738. doi: 10.5005/jp-journals-10071-23526.

Hyperkalemic Cardiac Arrest in a Patient with Diabetic Ketoacidosis.

Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine

Robin G Manappallil, Jayasree Nambiar

Affiliations

  1. Department of Internal Medicine, Baby Memorial Hospital, Calicut, Kerala, India.
  2. Department of Cardiology, Baby Memorial Hospital, Calicut, Kerala, India.

PMID: 33024389 PMCID: PMC7519603 DOI: 10.5005/jp-journals-10071-23526

Abstract

AIM: To highlight the occurrence of cardiac arrest due to hyperkalemia in diabetic ketoacidosis (DKA).

BACKGROUND: Diabetic ketoacidosis is a commonly encountered condition. These patients can have normal or mildly elevated levels of potassium. Our patient had severe hyperkalemia due to DKA resulting in cardiac arrest. Her high potassium diet and use of angiotensin receptor blocker along with acute kidney injury (AKI) would have also contributed to hyperkalemia.

CASE DESCRIPTION: A 58-year-old female, known case of diabetes mellitus on insulin therapy and hypertension on telmisartan, presented with nausea, vomiting, and abdominal pain. She was diagnosed to have DKA with AKI precipitated by missed insulin and urinary tract infection. She was also on high potassium diet. Her electrocardiogram showed sinus bradycardia with prolonged QRS interval. Her potassium levels were elevated. She soon went into asystole and cardiac arrest and was resuscitated. Diabetic ketoacidosis protocols were followed along with antibiotics, and the patient improved.

CONCLUSION: Severe hyperkalemia in DKA is uncommon, and this hyperkalemia resulting in cardiac arrest is an unreported scenario. Potassium correction along with DKA management protocol forms the mainstay of treatment.

CLINICAL SIGNIFICANCE: Mild to moderate elevation in serum potassium occurs frequently in DKA. However, severe hyperkalemia is uncommon and is likely to be the result of insulin deficiency, acidosis, hyperosmolality, severe dehydration, and renal potassium retention. Such elevated level of potassium requires urgent correction in order to prevent cardiac arrest.

HOW TO CITE THIS ARTICLE: Manappallil RG, Nambiar J. Hyperkalemic Cardiac Arrest in a Patient with Diabetic Ketoacidosis. Indian J Crit Care Med 2020;24(8):737-738.

Copyright © 2020; Jaypee Brothers Medical Publishers (P) Ltd.

Keywords: Cardiac arrest; Diabetes; Diabetic ketoacidosis; Hyperkalemia; Insulin; Urinary tract infection

Conflict of interest statement

Source of support: Nil Conflict of interest: None

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