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Generalized Weakness After Heavy Drinking: Hypokalemia? Ischemia?

Generalized Weakness After Heavy Drinking: Hypokalemia? Ischemia?

A 38-year-old Asian man with a history of hypertension, depression, and alcohol abuse presented to a walk-in clinic with total body weakness that started when he awoke that morning after drinking heavily the night before. He could barely walk because his legs were so weak; his arms were also extremely weak. He denied any neck or back pain or any numbness or tingling. He also denied headache, trauma, vomiting, tremors, anxiety, or other associated symptoms other than a little “heartburn” similar to what he has had in the past, especially after overeating or otherwise overindulging. He reported that he did not use illicit drugs or smoke tobacco, but said he drank about 12 beers the previous night, which was not unusual.

His medications included hydrochlorothiazide and fluoxetine, but he had not been taking either drug recently.

The patient’s vital signs were normal, except for his blood pressure of 158/94 mm Hg. Other physical findings were normal except for neurologic function. Although cranial nerve function, alertness, and sensation were normal, the patient had 4/5 strength in both arms and legs in symmetric fashion.

The clinic had a laboratory but no imaging services. An ECG was ordered (Figure) and an antacid was given by mouth. The patient’s heartburn resolved after approximately 15 minutes.

To what diagnosis do the ECG findings point?


Answer on next page...


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