Case Report Pseudomyocardial Infarction in a Patient with Severe Diabetic Ketoacidosis and Mild Hyperkalemia Edgar Francisco Carrizales-Sepúlveda , 1 Ángel Noé del Cueto-Aguilera, 1 Raúl Alberto Jiménez-Castillo, 1 Olga Norali de la Cruz-Mata, 1 Mariana Fikir-Ordoñez, 1 Raymundo Vera-Pineda, 1 Dalí Alejandro Hernández-Guajardo, 1 Alejandro Ordaz-Farías , 2 and Ramiro Flores-Ramírez 1,2 1 Internal Medicine Department, Hospital Universitario, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico 2 Echocardiography Laboratory, Cardiology Service, Hospital Universitario, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico Correspondence should be addressed to Edgar Francisco Carrizales-Sepúlveda; edgar.carri_89@hotmail.com Received 11 December 2018; Accepted 7 March 2019; Published 31 March 2019 Academic Editor: Man-Hong Jim Copyright © 2019 Edgar Francisco Carrizales-Sepúlveda et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. A 48-year-old male with a prior diagnosis of diabetes mellitus presented to the emergency department with malaise and nausea. On work-up, he was found with hyperglycemia and high anion gap metabolic acidosis, with a blood pH < 6 94. A diagnosis of severe diabetic ketoacidosis was established; serum electrolyte analysis showed mild hyperkalemia. On work-up, a 12-lead electrocardiogram was obtained, and it showed an ST-segment elevation on anterior leads that completely resolved with diabetic ketoacidosis treatment. ST-segment elevation myocardial infarction can be a precipitant factor for diabetic ketoacidosis, and evaluation of diabetic patients with suspected myocardial infarction can be challenging since they can present with atypical or little symptoms. Hyperkalemia, which usually accompanies diabetic ketoacidosis, can cause electrocardiographic alterations that are well described, but ST-segment elevation is uncommon. A pseudomyocardial infarction pattern has been described in patients with diabetic ketoacidosis; of note, most of these patients presented severe hyperkalemia. We believe this is of great importance for clinicians because they must be able to recognize those patients that present with electrocardiographic abnormalities secondary to the metabolic alterations and those that can be experiencing actual ongoing ischemia, in order to establish an appropriate and prompt treatment. 1. Introduction Heart tissue is particularly prone to the effects of systemic acidosis and hyperkalemia [1, 2]. Acidosis decreases myocar- dial contractibility by affecting the excitation-contraction coupling [1], and hyperkalemia causes depolarization of the cardiac-cell resting membrane potential, shortening of the action potential duration, and alterations in the conduction velocity [2]. Diabetic ketoacidosis (DKA) is considered one of the most serious acute complications of diabetes mellitus; it is characterized by hyperglycemia, metabolic acidosis, and increased total body ketone concentrations [3]. Despite volume depletion seen in DKA secondary to vomiting and reduced oral intake, serum potassium levels are typically high at presentation; this is because lack of insulin and the pres- ence of acidosis cause a shift of potassium from the intracel- lular space to extracellular space which usually resolve with DKA treatment [3, 4]. Thus, as a consequence of the acid- base and potassium derangements, patients with DKA can present electrocardiographic alterations than can be transient and resolve with treatment. 2. Case Report A 48-year-old male presented to the emergency department with complaints of malaise and nausea. The past medical Hindawi Case Reports in Cardiology Volume 2019, Article ID 4063670, 4 pages https://doi.org/10.1155/2019/4063670