Myocardial injury with biomarker elevation in diabetic ketoacidosis.
We report of two patients with severe ketoacidosis, minute elevations of myocardial biomarkers (troponin T and CK-MB) and initial ECG changes compatible with myocardial infarction (MI). All successive investigations, including coronary arteriography, were normal, and the patients recovered fully without further evidence of ischemic heart disease. We suggest that acidosis and very high levels of free fatty acids could cause membrane instability and biomarker leakage. Regardless of the pathogenesis, these two case stories suggest that nonspecific myocardial injury may occur in severe diabetic ketoacidosis and that the presence of minute biomarker elevation and ECG changes does not necessarily signify MI.
Moller
Niels
N
Medical Department M (Endocrinology and Diabetes), Aarhus University Hospital, Aarhus DK-8000, Denmark. nielsem@dadlnet.dk
Foss
Anne-Catherine H
AC
Gravholt
Claus H
CH
Mortensen
Ulrik M
UM
Poulsen
Steen Hvitfeldt
SH
Mogensen
Carl E
CE
D000328:Adult; D015415:Biomarkers / Q000097:blood; D003402:Creatine Kinase / Q000097:blood*; D016883:Diabetic Ketoacidosis / Q000378:metabolism* / Q000473:pathology; D005230:Fatty Acids, Nonesterified / Q000378:metabolism; D005260:Female; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000378:metabolism* / Q000473:pathology; D020107:Troponin T / Q000097:blood*
D015415:Biomarkers; D005230:Fatty Acids, Nonesterified; D020107:Troponin T; D003402:Creatine Kinase