Severe hypothermia with Osborn waves in diabetic ketoacidosis.

Diabetic ketoacidosis causes substantial morbidity and mortality.1 Though the management of acute diabetic ketoacidosis centers on correcting hyperglycemia and electrolyte abnormalities, other important metabolic derangements may be seen. Specifically, hypothermia may be both a cause and consequence of diabetic ketoacidosis, and the severity of the hypothermia correlates with the severity of the illness. The case presented below highlights a presentation of severe diabetic ketoacidosis associated with hypothermia, which caused distinctive changes (Osborn waves) on the electrocardiogram (ECG). In the setting of diabetic ketoacidosis the recognition of ECG changes characteristic of hypothermia will help guide management and avoid the misdiagnosis of an ST-segment elevation myocardial infarction.