A Case of Slowly Progressive Type 1 Diabetes Mellitus With Asymptomatic Myocardial Injury During Diabetic Ketoacidosis Treatment

Abstract

A 65-year-old man with slowly progressive type 1 diabetes mellitus (DM) was hospitalized with diabetic ketoacidosis (DKA). He underwent 19 hours of insulin therapy and hydration, and had no chest pain. However, electrocardiography (ECG) revealed ST elevation in leads I-III, aV_F, V₅ and V₆. His serum creatine phosphokinase rapidly increased to 1,983 U/L and he was positive for troponin T. Coronary angiography (CAG) revealed diffuse hypokinesis of the left ventricle without coronary artery stenosis. The patient was finally diagnosed with asymptomatic myocardial damage due to viral infection and his serum phosphorus level rapidly fluctuated during treatment for DKA. We should pay attention to myocardial damage in patients without symptoms at the beginning of DKA treatment.