Case 14: EKG in a Diabetic
An young man presents to the ED tachypneic and dehydrated. His accucheck is “High” and your keen nose smells 4+ ketones. The nurse asks you if you want to start an insulin drip. The EMT hands you the EKG below. What does it show? What is your next step?
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ANSWER:The EKG shows “Himalayan T-waves” and no you should not start an insulin drip yet. Before starting any insulin on a diabetic (or Lasix on a patient with CHF for that matter) you need to know what the potassium level is. Certain medications can cause or worsen hypokalemia and THAT can cause a potentially fatal arrhythmia. This patient had a Potassium of 1.8. Fortunately it was repleted prior to initiation of insulin therapy. The patient was admitted to the ICU.
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EKG Changes in Hypokalemia from Side Kick: Emergency Medicine
K > 2.6: U wave, flat T, (U>T in V2+V3).
K < 2.6: Himalayan T waves > wide QRS
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Time: January 7, 2007, 3:42 pm
[…] MEDICAL MYSTERY OF THE MONTH Happy New Year. Here is the January ‘07 Mystery. Please forward to your colleagues. For prior mysteries and more, check the menue bar on the website. * A young man presents to the ED tachypneic and dehydrated. His accucheck is “High” and your keen nose smells 4+ ketones. The nurse asks you if you want to start an insulin drip. The EMT hands you the EKG below. What does it show? What is your next step? (Click Here to find the answer) **** […]