Increased cardiac troponin I concentration in diabetic ketoacidosis

Objective: To examine the hypothesis that diabetic ketoacidosis may be associated with some degree of induced injury to heart muscle, related either to acidosis or hyperglycemia. Methods: Nineteen diabetic patients with acute ketoacidosis and 19 healthy children were enrolled in this study. Cardiac troponin I (cTnI), creatine kinase (CK)-MB and myoglobin levels were analyzed soon after admission and after 24 h. Patients were subdivided into two groups according to blood pH. Results: At the time of admission, the diabetic patients had significantly higher values than the controls for cTnI (0.193 +/- 0.008 vs 0.176 +/- 0.006 ng/dl; p < 0.001), CK-MB (24.1 < 2.1 vs 22.7 < 1.2 U/l; p = 0.02), and myoglobin (85.5 < 7.4 vs 52.5 +/- 8.3 mug/dl; p < 0.001). The diabetic patients also had significantly higher values than the controls for CK-MB (24 2.1 vs 22.7 +/- 1.2 U/l; p = 0.02) and for myoglobin (78.5 +/- 2.5 vs 52.5 +/- 8.3 mug/dl; p < 0.001) at 24 h. cTnI had normalized in patients at 24 h. All parameters were significantly different between patients with pH greater than or equal to7.0 and patients with pH <7.0. In addition, serum cTnI levels correlated negatively. with blood pH (r = -0.57, p = 0.026) and HCO3- (r = -0.65, p = 0.008) in the patients with diabetic ketoacidosis on admission. Conclusion: Our findings suggest that diabetic ketoacidosis, particularly when severe, has a detrimental effect on the myocardium.