The concurrence of acute myocardial infarction (AMI) and diabetic ketoacidosis can be a diagnostic and therapeutic challenge. The situation is associated with a significant morbidity and mortality.
Clinical situation:
(1) presence of diabetic ketoacidosis (DKA)
(2) presence of acute myocardial infarction (AMI)
(3) variable presence of infection or other trigger
It may be difficult to determine which came first, since DKA can trigger AMI and vice versa.
The diagnosis of myocardial infarction probably should go beyond an elevated serum troponin.
Management requires treatment of the conditions concurrently.
Special problems:
(1) severe acidosis
(2) cardiogenic shock
(3) diabetic nephropathy (which may be an issue for percutaneous coronary intervention)
(4) abnormal electrolytes (hypercalcemia, hyperkalemia, etc)
Other causes of ketoacidosis (alcohol, etc) would be faced with similar challenges
