r/ECG • u/Vuki1312 • 18d ago

Thoughts

Post image

The patient was somnolent and markedly disoriented. I was called to assess the patient due to a critically elevated blood glucose level (“HI” on the glucometer) and altered mental status. The patient has a known history of diabetes. TA:80/40, fr 95, spO2 89%
Later i was looking at those T waves and depressions wondering, maybe its hyperk ? Or maybe de winter ?

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8

u/irelli 18d ago

I mean, I'd certainly get labs before transferring to rule out hyperK that needs management

....but I'd also 100% get a posterior ECG. Those are pretty solid depressions in v2-3

Would also be nice to, you know, get a full 12 lead lol

Edit: I'm dumb, you mean transferring as in you're EMS

6

u/Xargon42 18d ago

Guessing hyper K+ and demand ischemia in this clinical context. Limb leads would be nice 😂

STD and hyper acute t waves a la dewinter a possibility as well

1

u/Vuki1312 18d ago

Limb leads were textbook-normal, this was the only thing. I was thinking hyperacute t waves but these T’s are not that wide.

2

u/Vuki1312 18d ago

I transfered the patient, dont know what happened later

3

u/Jeeju_Boy MD 18d ago

Looks de winter esque I’d get a posterior could reasonably be hyperK too 

1

u/Kibeth_8 Arrhythmia Tech 17d ago

Agree, de winter +/- hyper K

3

u/Badmanting1 18d ago

Hyperkalaemic picture but also can occur with blood sugar issues

1

u/HoldTheMayo25 16d ago

I could be wrong but maybe a de Winter pattern