Sinus arrest associated with diabetic ketoacidosis regressing to sinus rhythm after compensation of diabetic process: a case report and review of literature

Abstract Background Diabetic ketoacidosis (DKA) is a serious, life-threatening condition known for its profound hydro electrolytic disturbances and multiple complications, including cerebral edema and circulatory collapse. While this complication is traditionally associated with patients suffering from type 1 diabetes, numerous studies have documented its non-negligible incidence in type 2 diabetics. However, conductive disorders that manifest during its course, such as sinus arrest, are poorly reported and can be life-threatening on their own when not promptly recognized and treated. The primary objective of this report is to increase awareness regarding the uncommon conduction complications associated with diabetic ketoacidosis, even in the absence of overt hyperkalemia, and to underscore the critical significance of early diagnosis and prompt intervention in managing these complications. Case presentation We present the case of a middle-aged man with past history of type 2 diabetes whose symptoms included asthenia and consciousness disorder concomitant with ketoacidosis decompensation. Electrocardiogram (ECG) revealed the presence of sinus arrest with ventricular escaping rhythm. Rapid management of the diabetic decompensation led to spontaneous restoration of normal sinus rhythm, thus obviating the necessity for permanent pacing in the patient. Conclusions Atypical complications arising during ketoacidosis decompensation, including conditions like sinus arrest, are frequently overlooked and tend to carry a guarded prognosis. Proper recognition and prompt treatment are imperative to achieve the optimal clinical outcome.