Research Article
Volume 5 Issue 4 - 2021
Wavy Triple Sign of Hypocalcemia or Yasser’s Sign-In Diabetic Ketoacidosis; Reversal Effect and Diverse Management; Retrospective-Observational Study
Yasser Mohammed Hassanain Elsayed*
Damietta Health Affairs, Egyptian Ministry of Health (MOH), Damietta, Egypt
*Corresponding Author: Yasser Mohammed Hassanain Elsayed, Damietta Health Affairs, Egyptian Ministry of Health (MOH), Damietta, Egypt.
Received: May 22, 2021; Published: May 28, 2021




Abstract

Aim of the Study: Clarification for the effect of management of diabetic ketoacidosis on both hypocalcemia and electrocardiographic “Wavy triple sign or Yasser’s sign” is the target for the current study.

Background: Hypocalcemia is a well-known serious electrolyte disturbance characterized by calcium deficiency. Diabetic ketoacidosis is a life-threatening problem that affects people with diabetes that usually associated with electrocardiographic and electrolytes changes such as hypocalcemia. An electrocardiographic Wavy triple sign (Yasser’s sign) of hypocalcemia is a new diagnostic sign seen in 97.3% of hypocalcemia.

Method of Study and Patients: The author reported retrospective-observational 27-case report series. The study was conducted in Fraskour Central Hospital in the intensive care unit thorough nearly 15-months, starting from January 14, 2019 and ended on July 12, 2020. All included cases were latent hypocalcemia. Oral calcium and vitamin D preparation on discharge was supplied.

Results: The mean age was: 44.6 years, with female sex predominance (63%). The main complaints in the study were tachypnea (81.48%) vs. and tachypnea with chest pain (18.5%). Diabetic ketoacidosis (70.37%) and combined diabetic ketoacidosis with ischemic heart disease (11.11%) are the most common risk factors. All cases were latent tetany. Complete electrocardiographic recovery without calcium administration in 85.19% vs. nearly normalized response in 11.11% and non-response in 3.7%.

Conclusion: The wavy triple an electrocardiographic sign (Yasser’s sign) and hypocalcemia are commonly seen in diabetic ketoacidosis. Dramatic spontaneous improvement of both wavy triple an electrocardiographic sign (Yasser’s sign) and hypocalcemia simultaneously after the management of diabetic ketoacidosis in most cases.

 

Keywords: Wavy Triple an Electrocardiographic Sign; Yasser’s Sign in Hypocalcemia; Hypocalcemia; Tetany; Diabetic Ketoacidosis; Reversal Effect

References

  1. O’Donovan DK. “The diagnosis of chronic latent tetany in adults”. Irish Journal of Medical Science (1926-1967) 20.5 (1945): 146-153.
  2. Suneja M. “Hypocalcemia” (2018).
  3. Aguilera IM and Vaughan RS. “Calcium and the anaesthetist”. Anaesthesia 8 (2000): 779-790.
  4. Fong J and Khan A. “Hypocalcemia: updates in diagnosis and management for primary care”. Canadian Family Physician2 (2012): 158-162.
  5. Sung JK., et al. “A Case of Hypocalcemia-Induced Dilated Cardiomyopathy”. Journal of Cardiovascular Ultrasound 1 (2010): 25-27.
  6. Jankowski S and Vincent JL. “Calcium Administration for Cardiovascular Support in Critically Ill Patients: When Is It Indicated?” Journal of Intensive Care Medicine 10 (1995): 91-100.
  7. Cooper MS and Gittoes NJ. “Diagnosis and management of hypocalcaemia”. British Medical Journal 7656 (2008): 1298-1302.
  8. Murphy E and Williams GR. “Hypocalcaemia”. Medicine 9 (2009): 465-468.
  9. Urbano FL. “Signs of Hypocalcemia: Chvostek’s and Trousseau’s Signs”. Hospital Physician (2000): 43-45.
  10. Soar J., et al. “European Resuscitation Council Guidelines for Resuscitation 2015 Section (2015): 3.
  11. Szczech LA. “The impact of calcimimetic agents on the use of different classes of phosphate binders: results of recent clinical trials”. Kidney International 90 (2004): S46-48.
  12. Kido Y., et al. “Hypocalcemia associated with 5-fluorouracil and low dose leucovorin in patients with advanced colorectal or gastric carcinomas”. Cancer8 (1996): 1794-1797.
  13. Recker RR., et al. “Safety of bisphosphonates in the treatment of osteoporosis”. The American Journal of Medicine2 (2009): S22-32.
  14. Stamp TC., et al. “Plasma levels and therapeutic effect of 25-hydroxycholecalciferol in epileptic patients taking anticonvulsant drugs”. British Medical Journal5831 (1972): 9-12.
  15. McCormick BB., et al. “Severe hypocalcemia following denosumab injection in a hemodialysis patient”. American Journal of Kidney Diseases4 (2012): 626-628.
  16. Dykes C and Cash BD. “Key safety issues of bowel preparations for colonoscopy and importance of adequate hydration”. Gastroenterology Nursing - LWW Journals1 (2008): 30-35.
  17. Niemeijer ND., et al. “Symptomatic hypocalcemia after sodium phosphate preparation in an adult with asymptomatic hypoparathyroidism”. European Journal of Gastroenterology and Hepatology4 (2008): 356-358.
  18. Singla S., et al. “Approach to a Case of Hypocalcaemia”. The Journal, Indian Academy of Clinical Medicine4 (2006): 292-301.
  19. Bringhurst FR., et al. “Hypocalcemic disorders”. In Larsen PR, Kronenberg HM, Shlomo M et al (editions). Williams Textbook of Endocrinology (2003): 1340-1348.
  20. Majid A and Wheeler B J. “Severe diabetic ketoacidosis complicated by hypocapnic seizure in Endocrinology, Diabetes and amp”. Metabolism Case Reports (2017): 1-4.
  21. Shoback D. “Clinical practice. Hypoparathyroidism”. The New England Journal of Medicine4 (2008): 391-403.
  22. Dusky BMR. “ECG Abnormalities Associated With Hypocalcaemia”. Chest2 (2001): 668-669.
  23. Bronsky D., et al. “Calcium and the electrocardiogram 7.6 (1961): 823-832.
  24. Eryol NK., et al. “Effects of calcium treatment on QT interval and QT dispersion in hypocalcemia”. The American Journal of Cardiology6 (2003): 750-752.
  25. Nijjer S., et al. “Hypocalcaemia, long QT interval and atrial arrhythmias”. BMJ Case Reports (2010).
  26. Shantsila E., et al. “Drug-induced QT-interval prolongation andproarrhythmic risk in the treatment of atrial arrhythmias”. EP Europace4 (2007): iv37-iv44.
  27. Bradley TJ., et al. “Long on QT and low on calcium”. Cardiology in the Young6 (2004): 667-670.
  28. Mangat JS., et al. “Hypocalcaemia mimicking long QT syndrome: case report”. European Journal of Pediatrics2 (2008): 233-235.
  29. Lehmann G., et al. “ECG changes in a 25-year old woman with hypocalcaemia due to hypoparathyroidism: hypocalcaemia mimicking acute myocardial infarction”. Chest1 (2000): 260-262.
  30. Goldberger A. “Clinical Electrocardiography: A Simplified Approach”. 8th edition. Philadelphia: Mosby Elsevier (2013): 96.
  31. Pallidis LS., et al. “A case of severe hypocalcemia mimicking myocardial infarction”. International Journal of Cardiology1 (1997): 89-91.
  32. Elsayed YMH. “Wavy Triple an Electrocardiographic Sign (Yasser Sign) in Hypocalcemia. A Novel Diagnostic Sign; Retrospective Observational Study”. EC Emergency Medicine and Critical Care (ECEC)2 (2019): 1-2.
  33. Elsayed YMH. “Hypocalcemia-induced Camel-hump T-wave, Tee-Pee sign, and Bradycardia in a Car-painter of a Complexed Dilemma: A Case Report”. Cardiac 1 (2020): 07.
  34. Goyal A and Bhimji SS. “Hypocalcemia” (2017).
  35. Tohme JF and Bilezekian JP. “Hypocalcemic emergencies”. Endocrinology and Metabolism Clinics of North America 2 (1993): 363-375.
  36. Eryol NK., et al. “Effects of calcium treatment on QT interval and QT dispersion in hypocalcemia”. The American Journal of Cardiology 6 (2003): 750-752.
  37. Knilans TK. “Chou's Electrocardiography in Clinical Practice”. 6TH Edit (2008):288.
  38. Lehmann G., et al. “ECG changes in a 25-year old woman with hypocalcaemia due to hypoparathyroidism: hypocalcaemia mimicking acute myocardial infarction”. Chest1 (2000): 260-262.
  39. Zhu H., et al. “Transient Hypoparathyroidism in Diabetic Ketoacidosis”. Global Journal of Obesity, Diabetes and Metabolic Syndrome 1 (2015): 009-011.
  40. Elsayed YMH. “Movable-Weaning off an Electrocardiographic Phenomenon in Hypocalcemia (Changeable Phenomenon or Yasser’s Phenomenon of Hypocalcemia)-Retrospective-Observational Study”. CPQ Medicine1 (2021): 1-35.
Citation: Yasser Mohammed Hassanain Elsayed. “Wavy Triple Sign of Hypocalcemia or Yasser’s Sign-In Diabetic Ketoacidosis; Reversal Effect and Diverse Management; Retrospective-Observational Study”. EC Diabetes and Metabolic Research 5.4 (2021): 49-70.

PubMed Indexed Article


EC Pharmacology and Toxicology
LC-UV-MS and MS/MS Characterize Glutathione Reactivity with Different Isomers (2,2' and 2,4' vs. 4,4') of Methylene Diphenyl-Diisocyanate.

PMID: 31143884 [PubMed]

PMCID: PMC6536005


EC Pharmacology and Toxicology
Alzheimer's Pathogenesis, Metal-Mediated Redox Stress, and Potential Nanotheranostics.

PMID: 31565701 [PubMed]

PMCID: PMC6764777


EC Neurology
Differences in Rate of Cognitive Decline and Caregiver Burden between Alzheimer's Disease and Vascular Dementia: a Retrospective Study.

PMID: 27747317 [PubMed]

PMCID: PMC5065347


EC Pharmacology and Toxicology
Will Blockchain Technology Transform Healthcare and Biomedical Sciences?

PMID: 31460519 [PubMed]

PMCID: PMC6711478


EC Pharmacology and Toxicology
Is it a Prime Time for AI-powered Virtual Drug Screening?

PMID: 30215059 [PubMed]

PMCID: PMC6133253


EC Psychology and Psychiatry
Analysis of Evidence for the Combination of Pro-dopamine Regulator (KB220PAM) and Naltrexone to Prevent Opioid Use Disorder Relapse.

PMID: 30417173 [PubMed]

PMCID: PMC6226033


EC Anaesthesia
Arrest Under Anesthesia - What was the Culprit? A Case Report.

PMID: 30264037 [PubMed]

PMCID: PMC6155992


EC Orthopaedics
Distraction Implantation. A New Technique in Total Joint Arthroplasty and Direct Skeletal Attachment.

PMID: 30198026 [PubMed]

PMCID: PMC6124505


EC Pulmonology and Respiratory Medicine
Prevalence and factors associated with self-reported chronic obstructive pulmonary disease among adults aged 40-79: the National Health and Nutrition Examination Survey (NHANES) 2007-2012.

PMID: 30294723 [PubMed]

PMCID: PMC6169793


EC Dental Science
Important Dental Fiber-Reinforced Composite Molding Compound Breakthroughs

PMID: 29285526 [PubMed]

PMCID: PMC5743211


EC Microbiology
Prevalence of Intestinal Parasites Among HIV Infected and HIV Uninfected Patients Treated at the 1o De Maio Health Centre in Maputo, Mozambique

PMID: 29911204 [PubMed]

PMCID: PMC5999047


EC Microbiology
Macrophages and the Viral Dissemination Super Highway

PMID: 26949751 [PubMed]

PMCID: PMC4774560


EC Microbiology
The Microbiome, Antibiotics, and Health of the Pediatric Population.

PMID: 27390782 [PubMed]

PMCID: PMC4933318


EC Microbiology
Reactive Oxygen Species in HIV Infection

PMID: 28580453 [PubMed]

PMCID: PMC5450819


EC Microbiology
A Review of the CD4 T Cell Contribution to Lung Infection, Inflammation and Repair with a Focus on Wheeze and Asthma in the Pediatric Population

PMID: 26280024 [PubMed]

PMCID: PMC4533840


EC Neurology
Identifying Key Symptoms Differentiating Myalgic Encephalomyelitis and Chronic Fatigue Syndrome from Multiple Sclerosis

PMID: 28066845 [PubMed]

PMCID: PMC5214344


EC Pharmacology and Toxicology
Paradigm Shift is the Normal State of Pharmacology

PMID: 28936490 [PubMed]

PMCID: PMC5604476


EC Neurology
Examining those Meeting IOM Criteria Versus IOM Plus Fibromyalgia

PMID: 28713879 [PubMed]

PMCID: PMC5510658


EC Neurology
Unilateral Frontosphenoid Craniosynostosis: Case Report and a Review of the Literature

PMID: 28133641 [PubMed]

PMCID: PMC5267489


EC Ophthalmology
OCT-Angiography for Non-Invasive Monitoring of Neuronal and Vascular Structure in Mouse Retina: Implication for Characterization of Retinal Neurovascular Coupling

PMID: 29333536 [PubMed]

PMCID: PMC5766278


EC Neurology
Longer Duration of Downslope Treadmill Walking Induces Depression of H-Reflexes Measured during Standing and Walking.

PMID: 31032493 [PubMed]

PMCID: PMC6483108


EC Microbiology
Onchocerciasis in Mozambique: An Unknown Condition for Health Professionals.

PMID: 30957099 [PubMed]

PMCID: PMC6448571


EC Nutrition
Food Insecurity among Households with and without Podoconiosis in East and West Gojjam, Ethiopia.

PMID: 30101228 [PubMed]

PMCID: PMC6086333


EC Ophthalmology
REVIEW. +2 to +3 D. Reading Glasses to Prevent Myopia.

PMID: 31080964 [PubMed]

PMCID: PMC6508883


EC Gynaecology
Biomechanical Mapping of the Female Pelvic Floor: Uterine Prolapse Versus Normal Conditions.

PMID: 31093608 [PubMed]

PMCID: PMC6513001


EC Dental Science
Fiber-Reinforced Composites: A Breakthrough in Practical Clinical Applications with Advanced Wear Resistance for Dental Materials.

PMID: 31552397 [PubMed]

PMCID: PMC6758937


EC Microbiology
Neurocysticercosis in Child Bearing Women: An Overlooked Condition in Mozambique and a Potentially Missed Diagnosis in Women Presenting with Eclampsia.

PMID: 31681909 [PubMed]

PMCID: PMC6824723


EC Microbiology
Molecular Detection of Leptospira spp. in Rodents Trapped in the Mozambique Island City, Nampula Province, Mozambique.

PMID: 31681910 [PubMed]

PMCID: PMC6824726


EC Neurology
Endoplasmic Reticulum-Mitochondrial Cross-Talk in Neurodegenerative and Eye Diseases.

PMID: 31528859 [PubMed]

PMCID: PMC6746603


EC Psychology and Psychiatry
Can Chronic Consumption of Caffeine by Increasing D2/D3 Receptors Offer Benefit to Carriers of the DRD2 A1 Allele in Cocaine Abuse?

PMID: 31276119 [PubMed]

PMCID: PMC6604646


EC Anaesthesia
Real Time Locating Systems and sustainability of Perioperative Efficiency of Anesthesiologists.

PMID: 31406965 [PubMed]

PMCID: PMC6690616


EC Pharmacology and Toxicology
A Pilot STEM Curriculum Designed to Teach High School Students Concepts in Biochemical Engineering and Pharmacology.

PMID: 31517314 [PubMed]

PMCID: PMC6741290


EC Pharmacology and Toxicology
Toxic Mechanisms Underlying Motor Activity Changes Induced by a Mixture of Lead, Arsenic and Manganese.

PMID: 31633124 [PubMed]

PMCID: PMC6800226


EC Neurology
Research Volunteers' Attitudes Toward Chronic Fatigue Syndrome and Myalgic Encephalomyelitis.

PMID: 29662969 [PubMed]

PMCID: PMC5898812


EC Pharmacology and Toxicology
Hyperbaric Oxygen Therapy for Alzheimer's Disease.

PMID: 30215058 [PubMed]

PMCID: PMC6133268


News and Events


November Issue Release

We always feel pleasure to share our updates with you all. Here, notifying you that we have successfully released the November issue of respective journals and the latest articles can be viewed on the current issue pages.

Submission Deadline for Upcoming Issue

Ecronicon delightfully welcomes all the authors around the globe for effective collaboration with an article submission for the upcoming issue of respective journals. Submissions are accepted on/before December 08, 2021.

Certificate of Publication

Ecronicon honors with a "Publication Certificate" to the corresponding author by including the names of co-authors as a token of appreciation for publishing the work with our respective journals.

Best Article of the Issue

Editors of respective journals will always be very much interested in electing one Best Article after each issue release. The authors of the selected article will be honored with a "Best Article of the Issue" certificate.

Certifying for Review

Ecronicon certifies the Editors for their first review done towards the assigned article of the respective journals.

Latest Articles

The latest articles will be updated immediately on the articles in press page of the respective journals.

Immediate Assistance

The prime motto of this team is to clarify all the queries without any delay or hesitation to avoid the inconvenience. For immediate assistance on your queries please don't hesitate to drop an email to editor@ecronicon.uk