Figure 1

Figure 2

"My Whole Body is Cramping, I ‘m Weak and I Cannot Eat"

Estak Choudhury, MD and Thomica James, MD

July 01, 2003

History of Present Illness
A 46-year-old female with history of alcohol abuse presented to the emergency department with a complaint of general weakness, cramps all over the body and an inability to open her mouth, which prevented her from taking in any food in the last two days. The patient denied trauma, recent illicit drug use, or use of any prescription medications. Her tetanus immunizations were complete and up to date.

Vital Signs
The patient had a temperature of 97.0, a heart rate of 114 beats per minutes and regular, a blood pressure of 116/70, and a pulse oximeter of 99% on room air.

Physical Exam
The patient was a disheveled and slightly emaciated female who appeared slightly anxious. She was unable to open her mouth and had difficulty talking. The neurological exam was impressive for 3+ DTR in the upper extremities symmetrically. The rest of the exam was unremarkable. While measuring the blood pressure on the opposite arm, the patient had spasm in her all extremities and started to have a generalized tonic clonic seizure that was brought under control after injecting 2 mg of lorazepam I.V. A bedside accu-Check™ was 90 and an EKG was obtained (figure 1).

How do you interpret the EKG results based on patient’s presentation?
How you explain the patient’s condition?

ANSWER