Transient anterior electrocardiographic changes simulating acute anterior myocardial infarction in diabetic ketoacidosis

In two patients with severe diabetic ketoacidosis, electrocardiography showed transient anterior changes suggestive of acute transmural infarction without subsequent evidence of myocardial necrosis. While the mechanism of these and other temporary electrocardiographic changes in diabetic ketoacidosis remains unclear, appreciation of their transient nature is essential if misdiagnosis of myocardial infarction and possible inappropriate delay in intravenous fluid administration are to be avoided. When electrocardiographic abnormalities are present early in diabetic ketoacidosis, the full 12-lead electrocardiogram should be repeated after adequate resuscitation.