Persistent Complete Heart Block Unmasked by Severe Diabetic Ketoacidosis in a Young Woman: A Case Report

Abstract

Background: Cardiac conduction disturbances are rare complications of diabetic ketoacidosis (DKA). They are usually transient and reversible with correction of metabolic abnormalities. Case Presentation: We report the case of a 27-year-old woman with type 1 diabetes who presented with DKA and was found to have a complete atrioventricular block (AVB) on admission. Despite standard management with intravenous insulin, isotonic saline, and potassium replacement, the patient developed severe hypokalemia complicated by ventricular fibrillation and cardiac arrest. Resuscitation was successful, and metabolic abnormalities were corrected; however, the complete AVB persisted. Outcome: A dual-chamber permanent pacemaker was implanted, with subsequent full recovery and discharge in stable condition. Conclusion: This case highlights that AVB in the context of DKA may not always be reversible. Persistent conduction disturbances, particularly when complicated by malignant arrhythmias, require timely pacemaker implantation and individualized management.