Wavy triple sign of hypocalcemia or yasser’s sign-in diabetic ketoacidosis; reversal effect and diverse management; retrospective-observational study

Title : Wavy triple sign of hypocalcemia or yasser’s sign-in diabetic ketoacidosis; reversal effect and diverse management; retrospective-observational study

Abstract:

Aim of the study: Clarification of 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 is 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 for nearly 15 months, starting on Jan 14, 2019, and, ending on Jul 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%.

Conclusions: The wavy triple 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

Biography:

Dr. Yasser Mohammed Hassanain Elsayed. Scientist, critical care physician, cardiologist, and independent researcher. Egyptian Ministry of Health. Publicized articles; (126). Innovations (10); (3) "Signs", (4) "Phenomena", (1) "Modification", (1) "Maneuver", and (1) “Method”. Speaker; (20) International conferences. Reviewer; (217) articles. Editor; (189) Journals. International Conferences OCM; (7). Instructor; (7) official and (80) non-official. COVID-19 publicized articles; (38). Prizes nomination; Breakthrough Prize and Einstein Prize. Excellence certificate (104). The most famous articles; 1. Wavy Triple an Electrocardiographic Sign (Yasser’s Sign) in Hypocalcaemia. 2. Graded Phenomenon (Yasser’s Phenomenon). 3. Connected Aircraft Squadron Electrocardiographic Sign (Yasser’s sign). 4. Electrocardiographic Passing Phenomenon (Flying Phenomenon or Yasser’s Phenomenon). 5. Movable-weaning off an electrocardiographic phenomenon in hypocalcemia (Yasser’s phenomenon of hypocalcemia). 6. Yasser’s COVID-19 Discrepancy phenomenon. 7. Yasser’s Maneuver for Regaining the Consciousness in the Psychogenic Coma. 8. Yasser’s Modification or Oxygen test in Coronary Artery Spasms. 9. Three and One Method (Yasser’s Method) to Overcome Streptokinase-Induced Hypotension in Acute Myocardial Infarction.