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당뇨병성 케톤산증의 회복 중에 발생한 Torsades de Pointes 유발 심정지 증례

Cardiac Arrest Related to Torsades de Pointes in a Patient Recovering from Diabetic Ketoacidosis

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Diabetic ketoacidosis (DKA) is an acute complication related to severe hyperglycemia. While the mortality rate for DKA is low with appropriate therapy, several complications may lead to deterioration of the clinical course. Here, we report a case of a 23-year-old patient with DKA who suffered from a rare but hemodynamically unstable cardiac arrhythmia, polymorphic ventricular tachycardia with prolonged QT interval, or Torsades de Pointes. During the recovery phase of DKA, three episodes of Torsades de Pointes suddenly occurred, and were recovered by immediate defibrillation. The patient did not have structural heart disease or a genetic predisposition. To the best of our knowledge, this is the first report of an adult with DKA complicated with QT prolongation related to Torsades de Points after correction of ketosis. To manage DKA, more attention may be needed on changes in the QT interval as well as risk factors for Torsades de Points.

Abstract

Diabetic ketoacidosis (DKA) is an acute complication related to severe hyperglycemia. While the mortality rate for DKA is low with appropriate therapy, several complications may lead to deterioration of the clinical course. Here, we report a case of a 23-year-old patient with DKA who suffered from a rare but hemodynamically unstable cardiac arrhythmia, polymorphic ventricular tachycardia with prolonged QT interval, or Torsades de Pointes. During the recovery phase of DKA, three episodes of Torsades de Pointes suddenly occurred, and were recovered by immediate defibrillation. The patient did not have structural heart disease or a genetic predisposition. To the best of our knowledge, this is the first report of an adult with DKA complicated with QT prolongation related to Torsades de Points after correction of ketosis. To manage DKA, more attention may be needed on changes in the QT interval as well as risk factors for Torsades de Points.

참고문헌 (8)

  1. Fayfman M, "Management of hyperglycemic crises : diabetic ketoacidosis and hyperglycemic hyperosmolar state", Med Clin North Am, 101, pp.587~606 (2017)
  2. Thomas N, "Supraventricular tachycardia in association with diabetic ketoacidosis", Br J Diabetes Vasc Dis, 7, pp.244~245 (2007)
  3. Kuppermann N, "Prolonged QT interval corrected for heart rate during diabetic ketoacidosis in children", Arch Pediatr Adolesc Med, 162, pp.544~549 (2008)
  4. Ninkovic VM, "Prevalence and risk factors for prolonged QT interval and QT dispersion in patients with type 2 diabetes", Acta Diabetol, 53, pp.737~744 (2016)
  5. Perez MM, "QTc Prolongation in pediatric patients with diabetic ketoacidosis", J Pediatr, 228, pp.235~239 (2021)
  6. Khalil OA, "Prolonged QTc interval in adults with diabetic ketoacidosis : is it only electrolyte disturbance?", Egypt J Intern Med, 31, pp.136~141 (2019)
  7. Wallace E, "Long QT syndrome : genetics and future perspective", Pediatr Cardiol, 40, pp.1419~1430 (2019)
  8. Pickham D, "Hyperglycemia is associated with corrected QT prolongation and mortality in acutely ill patients", J Cardiovasc Nurs, 29, pp.264~270 (2014)

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