Triage: Brought by ambulance. Too weak to get out of bed this morning. Denies PMH. Flat affect
History of Present Illness: An Asian man in his late teens with no past medical history is brought to the ER for severe generalized weakness upon waking up to try to pee around 4:30 am. He admits to some palpitations and anxiety but denies any pain, dyspnea, drug use or recent injury
Vital signs: Pulse 108, BP 145/83, RR 18, temp 98.8
Physical exam: Can wiggle toes and fingers and moves hands and feet a little but cannot lift arms or legs off the bed
An ECG is done
Computer Read: Sinus rhythm, 1st degree AV block, possible RVH, long QT
What should you do next?
- A) Activate stroke code
- B) MRI cervical spine
- C) Psychiatry consult
- D) Empiric magnesium administration
- E) None of the above
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My ECG interpretation: These are Himalayan T-waves from TU fusion from severe hypokalemia, which is consistent with weakness from hypokalemic periodic paralysis. He is Asian which is one of the risk factors
What is the most likely cause of the chest pain in this patient?
- A) Activate stroke code
- B) MRI cervical spine
- C) Psychiatry consult
- D) Empiric magnesium administration
- E) None of the above – CORRECT – Give empiric potassium. You can certainly add some magnesium as well
1-Minute EM Consult on the topic for this case from the Emergency Medicine 1-minute Consult Pocketbook
Case conclusion: Labs were ordered and psychiatry was consulted, and during the consultation the patient had a cardiac arrest. Code blue was called and he was resuscitated. His potassium level came back during code blue as a critical value of 1.5 mEq/L