ECG in Diabetic Ketoacidosis

Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes mellitus that carries a significant mortality despite intensive modern therapy with fluid and electrolyte replacement, insulin administration, correction of acidosis, and management of precipitating factors. A rapid and often precipitous fall in the serum electrolyte level may occur in DKA after initiation of therapy. The ECG is a valuable and readily available indicator of such changes, though not a substitute for the serum electrolyte determinations, and can be used to make intelligent decisions in the management of DKA.1 REPORT OF CASES Case 1. —A 47-year-old man with diabetes mellitus of 13 years' duration was admitted to the hospital with a two-day history of palpitations and vomiting. He had had an episode of supra-ventricular tachycardia six months earlier. On examination, his temperature was 36.6 °C; pulse, 142 beats per minute and irregular; BP, 136/80 mm Hg; and respirations, 40/min. Auscultation of