Monday, November 29, 2021

A Pathognomonic ECG. What is it? (Hint: 2 diagnoses in one)

I was reading through the list of EKGs and saw this one.  What is it diagnostic of? (hint: 2 diagnoses in one)

There is a very long, flat, ST segment, resulting in a long QT (most long QT is due to a wide T-wave, not a long ST segment).  This is diagnostic of hypocalcemia.  There are also peaked T-waves of hyperkalemia.  This is a common combination in dialysis patients.

The ionized calcium was 2.29 mg/dL (normal is 4.40-5.20).  The K was 6.2 mEq/L.

Here are the symptoms she had (very typical for hypocalcemia):

Dialysis patient with left upper extremity numbness and tingling, lightheadedness, perioral numbness and tingling, and bilateral lower extremity stocking glove numbness and tingling. 

She was given 6 grams of calcium gluconate and K was shifted.

Here is the subsequent ECG:

All findings are corrected

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