Triage: Decreased PO intake and vomiting for 4 days, feeling weak, states has lost 19lbs in 2 months

History of Present Illness: A man in his mid 50’s presents with 2 months of weight loss of 20 pounds due to anorexia and 2 days of generalized weakness and vomiting.  He denies abdominal pain or diarrhea.  He has a history of HTN and alcohol use disorder but says he has been sober for 3 weeks.

Vital Signs: 36.7, pulse of 122, RR of 16,  BP of 139/66.

Physical Exam: Quite thin but not cachectic.  Hard of hearing.  Mild epigastric tenderness

An ECG is done 

Computer Read: Sinus tach at 116, ST deviation and moderate T wave abnormality consider inferior ischemia

What is the most likely cause of ECG findings in this patient?

  • A) None of the below
  • B) Blood clot (PE)
  • C) ACS
  • D) Drug toxicity
  • E) Electrolyte issue

ANSWERS & 1-MINUTE CONSULT

 

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My ECG interpretation: There is sinus tachycardia at 116, as well as ST deviation and moderate T wave abnormality but there are other causes than ischemia, such as an electrolyte abnormality, which fits much better with the clinical picture.  Here it is most suggestive of hypokalemia

 

 

 

 

ANSWER:

  • A) None of the below
  • B) Blood clot (PE)
  • C) ACS
  • D) Drug toxicity
  • E) Electrolyte issue- CORRECT – K was 2.5

1-Minute Consult on this topic: Click HERE and scroll to hypokalemia

 

CASE CONCLUSION: Admitted for oral and IV potassium repletion.  His blood pressure medications were also switched to get him off a thiazide diuretic.  His magnesium was also low and was repleted.  With there measures his potassium normalized and he was discharge home the next afternoon

CASE LESSONS:

  1. Electrolyte abnormalities often cause ECG abnormalities that can mimic ischemia
  2. Common causes of hypokalemia include diarrhea, medications like HCTZ or PPIs as well as low magnesium and alcohol abuse