title: Looking at diabetic ketoacidosis through electrocardiogram window!
abstract: BACKGROUND
  Initial serum potassium (K+) in diabetic ketoacidosis (DKA) often does not reflect the true amount of total body K+ storage, and it is not a good predictor of subsequent hypokalemia. In this study, we tested the hypothesis that a deficiency of the total body K+ storage can be detected initially on surface electrocardiography (ECG).
  
  
  METHODS
  Medical records of 350 patients with a diagnosis of DKA were reviewed. Data regarding serial basic metabolic panels, arterial blood gases, serum ketones, and total K+ replacement that patient received during admission were collected. We compared biochemical findings for patients with and without QTU corrected (QTUc) prolongation by using the t test. Patients who were taking medications known to affect QTUc or cause ST-T changes were excluded.
  
  
  RESULTS
  After exclusion criteria, 61 patients were enrolled in this study. In 38 patients (62.9%), QTUc was more than or equal to 450 milliseconds. Patients with prolonged QTc received statistically more K+ supplementation during admission (P = .014). They also had lower serum K+ level during their hospital course (P = .002) compared to patients with normal QTUc intervals. No significant difference was found between initial serum K+, calcium, glucose, anion gap, acidosis, age, or heart rate between these 2 groups.
  
  
  CONCLUSIONS
  The significant relationship between K+ depletion and the ECG changes observed in this study deserves further consideration. Our findings confirm the concept that the ECG is an easy and reliable tool for early diagnosis of hypokalemia in patients with DKA.
authors.affiliation: Medicine Department, Metropolitan Hospital, New York Medical College, New York, NY 10029.
authors.forename: Soheila
authors.initials: S
authors.lastname: Talebi
authors.affiliation: Emergency Department, Metropolitan Hospital, New York Medical College, New York, NY 10029.
authors.forename: Farzaneh
authors.initials: F
authors.lastname: Ghobadi
authors.affiliation: Medicine Department, Metropolitan Hospital, New York Medical College, New York, NY 10029.
authors.forename: Arthur
authors.initials: A
authors.lastname: Cacacho
authors.affiliation: Medicine Department, Metropolitan Hospital, New York Medical College, New York, NY 10029.
authors.forename: Ola
authors.initials: O
authors.lastname: Olatunde
authors.affiliation: Emergency Department, Metropolitan Hospital, New York Medical College, New York, NY 10029.
authors.forename: Alicia
authors.initials: A
authors.lastname: DeRobertis
authors.affiliation: Cardiology Department, Metropolitan Hospital, New York Medical College, New York, NY 10029.
authors.forename: Gerald
authors.initials: G
authors.lastname: Pekler
authors.affiliation: Cardiology Department, Metropolitan Hospital, New York Medical College, New York, NY 10029.
authors.forename: Ferdinand
authors.initials: F
authors.lastname: Visco
authors.affiliation: Cardiology Department, Metropolitan Hospital, New York Medical College, New York, NY 10029.
authors.forename: Savi
authors.initials: S
authors.lastname: Mushiyev
authors.affiliation: Emergency Department, Metropolitan Hospital, New York Medical College, New York, NY 10029. Electronic address: getawh@yahoo.com.
authors.forename: Getaw Worku
authors.initials: GW
authors.lastname: Hassen
mesh_terms: D000328:Adult; D001639:Bicarbonates / Q000097:blood; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000032:analysis; D016883:Diabetic Ketoacidosis / Q000097:blood* / Q000503:physiopathology*; D004562:Electrocardiography; D005260:Female; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D011188:Potassium / Q000097:blood*; D012307:Risk Factors
chemical_list: D001639:Bicarbonates; D015415:Biomarkers; D001786:Blood Glucose; D011188:Potassium