Stress cardiomyopathy – a unique presentation of diabetic ketoacidosis

This version was published on 1 May 2009

Ann Clin Biochem 2009;46:257-260
© 2009 Association for Clinical Biochemistry


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Case Reports

Sudip Nanda1,
Santo Longo2,
Surya Prakash Bhatt1,
John Pamula1,
Shree Gopal Sharma3 and
Thompson H Dale4

1 Department of Internal Medicine;
2 Department of Pathology, St. Luke’s Hospital, Bethlehem, PA;
3 Department of Pathology, University of Arkansas, Little Rock, AR;
4 Department of Cardiology, St. Luke’s Hospital, Bethlehem, PA 18015, USA

Corresponding author: Sudip Nanda. Email: sudipnanda2000{at}

We have documented a unique instance of diabetic ketoacidosis(DKA)-induced stress-related cardiomyopathy (CMP) in a 46-yr-oldCaucasian female with type I diabetes mellitus. In times ofstress, tissues with high capacity for aerobic metabolism, likemyocardium, can preferentially change their metabolic substrateto ketones. The myocyte has a decreased ability to metabolizeglucose and free fatty acids in stress CMP. To the best of ourknowledge this is the first report of stress CMP complicatingDKA. A possible mechanism for the same is hypothesized.

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