Which diagnostic test should be obtained for every patient with DKA or HHS to assess for electrolyte disturbances and potential underlying causes such as myocardial infarction?

• A. EKG
• B. Chest X-ray
• C. Abdominal ultrasound
• D. Brain MRI

Answer: (A)

In DKA or HHS, immediate concerns include dangerous electrolyte disturbances that can disrupt heart rhythm, and an acute myocardial infarction can trigger the crisis. An electrocardiogram is the key test because it gives rapid, direct information about the heart’s rhythm and conduction, which can be altered by electrolyte abnormalities (for example, hyperkalemia or hypokalemia) and can also reveal ischemia or infarction.

This test is fast, noninvasive, and inexpensive, and the results directly guide urgent management—such as addressing potassium abnormalities and deciding on telemetry or further cardiac workup if there are signs of ischemia. Chest X-ray, abdominal ultrasound, or brain MRI don’t reliably assess electrolyte-related conduction disturbances or acute coronary injury in the initial evaluation, making them less appropriate as the first test for this purpose.