HYPOGLYCEMIA-INDUCED ISCHEMIC ECG-CHANGES

A patient with an 8 year history of insulin-dependent diabetes mellitu s was admitted to the emergency ward for hypoglycaemic coma (blood glu cose 1.11 mmol/l). The initial electrocardiogram revealed a junctional rythm and major ischaemia with an ST depression of 6-7 mm. Sinus ryth m and normal repolarization were recovered 15 minutes after administra tion of 50% glucose. No evidence of mycardial infarction appeared duri ng follow-up. Such hypoglycaemia-induced ECG changes have rarely been documented and no conclusive explanation has been put forward although altered balance between energy supply and demand in myocardial tissue has been suggested. Special care should be taken when administrating hypoglycaemic agents to patients at risk for myocardial ischaemia.