Case Report: Older Woman with 6 Days of Vomiting and Diarrhea

Author(s):

Check out our latest case report from Dr. Brady Pregerson, which features a smoker in her 60 with a history of COPD presenting with 6 days of vomiting and diarrhea and 1 day of constant LLQ pain. Can you determine the correct diagnosis?

History: A woman in her 60’s with a history of COPD (who still smokes) presents to the ED for 6 days of vomiting and diarrhea and 1 day of constant LLQ pain. She denies fever, bleeding, recent travel or antibiotic use, chest pain, SOB that is any worse than her usual baseline or any other complaints.

Exam: Vital signs are normal except for a pulse ox of 92% on room air, which she thinks may be normal for her and a temperature of 99.4. Exam is remarkable for diffuse abdominal tenderness without rebound that is more pronounced on the left than on the right.

An EKG is done:

Computer Read:

NSR at 86 with PR 152ms, QRS or 84ms and QTc 379ms
Low voltage in precordial leads
Possible anterior MI, probably old

What is the most likely cause of the EKG findings?

A) Hyperkalemia

B) Hypokalemia

C) Hypomagnesemia

D) ACS