, Volume 16, Issue 2, pp 316-320
Date: 22 Jan 2009

Perfusion and wall motion abnormalities in a patient with diabetic ketoacidosis

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Case Presentation

A 54-year-old Caucasian postmenopausal woman with type II diabetes mellitus, on insulin therapy for 5 years, and hypercholesterolemia presented to the emergency department with complaints of nausea, diarrhea, and vomiting for 1 day. On examination, she was short of breath, her heart rate was 130 beats/minute and regular, blood pressure was 140/78 mm Hg, and respiratory rate was 35 breaths/minute. Cardiac examination was unremarkable and the lungs were clear to auscultation. The laboratory results were consistent with diabetic ketoacidosis (DKA): arterial blood gas pH = 7.00, anion gap = 28, serum blood glucose = 462 mg/dL, serum acetone positive and urine positive for ketones. She had no prior history of coronary artery disease and no difficulty in controlling her blood glucose levels until one day prior to admission. In reviewing her social history, she was content with her work and family life, with no history of drug or alcohol use and no emotional stressors. ECG sh