Saurabh Kumbhar, Rajshekhar Lohar, Abhijeet Haldhar, Ravi Kant

DIABETIC KETOACIDOSIS AND MYOCARDIAL INFARCTION- A DIAGNOSTIC AND THERAPEUTIC CHALLENGE

  • General Medicine
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  • Ocean Engineering
  • General Medicine
  • General Medicine
  • General Medicine
  • General Medicine
  • General Earth and Planetary Sciences
  • General Environmental Science
  • General Medicine
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In patient with acute myocardial infarction with acute left ventricular failure and concomitant Diabetic ketoacidosis, diagnostic and therapeutic dilemma possess a signicant challenge in management. A 62 year diabetic male presented acute onset epigastric pain and acute onset shortness of breath for 8 hours. Physical examination showed bilateral basal pulmonary crackles. ECG was suggestive of T wave inversions in antero-lateral leads and troponin levels were elevated. Random blood sugar level was 450 mg/dL and blood gas analysis showed type 1 respiratory failure with high anion gap metabolic acidosis and positive urine ketones. Severity of ketoacidosis incites one to initiate aggressive uid therapy but the in presence of acute heart failure it can worsen pulmonary congestion. Hence, early diagnosis and treatment modication in form of restricted uid therapy with continuous clinical and echocardiographic monitoring is required.

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