Medical errors in providing emergency care to patients with ECG symptoms of acute coronary syndrome on the background of decompensation of diabetes mellitus with hyperkalemia

Authors

DOI:

https://doi.org/10.14739/2310-1237.2021.2.225044

Keywords:

diabetes mellitus, acute coronary syndrome, insulin, ketoacidosis, arrhythmia, amiodarone, hyperkalemia

Abstract

The article describes a rare clinical case of hyperkalemia backgrounded by type 1 diabetes mellitus with signs of acute cardiovascular insufficiency, arrhythmia and QRST disturbances which was primarily diagnosed as acute coronary syndrome with ST elevation. Coronary angiography excluded pathology of the coronary arteries. Hyperkalemia, as the cause of ECG changes, was suspected in the hospital treatment. Stabilization of the patient’s condition, renewal of heart rhythm and conduction was obtained against the background of infusion support and insulin therapy. The pathogenesis of arrhythmia and QRST complex had a secondary genesis in relation to fluid and electrolyte metabolism disorders, so the restoration of sinus rhythm occurred without usage of antiarrhythmics. The usage of antiarrhythmic drugs according to the guideline of management of patients with ACS can deepen electrolyte shifts and lead to fatal arrhythmias in conditions of insulin deficiency and hyperkalemia.

This example illustrates the urgent need to diagnose life-threatening electrolyte changes, namely hyperkalemia, under the guise of acute coronary syndrome, as well as signs of ACS, along with ECG, to pay special attention to the assessment of medical history and clinical data for the correct choice of emergency care and further treatment tactics.

Author Biographies

O. M. Toronchenko, Poltava State Medical University, Ukraine

MD, PhD, Assistant of the Department of Internal Medicine 2 with Occupational Diseases

L. О. Miakinkova, Poltava State Medical University, Ukraine

MD, PhD, Associate Professor of the Department of Internal Medicine 2 with Occupational Diseases

D. D. Baklytskyi, Municipal Enterprise “Poltava Regional Clinical Medical Cardiovascular Center of Poltava Regional Council”, Ukraine

Cardiologist, Head of the Department of Interventional Cardiology with CCRU and X-ray Surgical Unit

Published

2021-08-20

How to Cite

1.
Toronchenko OM, Miakinkova LО, Baklytskyi DD. Medical errors in providing emergency care to patients with ECG symptoms of acute coronary syndrome on the background of decompensation of diabetes mellitus with hyperkalemia. Pathologia [Internet]. 2021Aug.20 [cited 2024Nov.8];18(2):243-50. Available from: http://pat.zsmu.edu.ua/article/view/225044

Issue

Section

Case Reports