Do you recognize this ECG yet?

Case contributed by Dr. David GordonSee if you can recognize this ECG without the clinical context:Sinus tachycardiaWide QRSTerminal R-wave in aVR, V1, and V2 with STE and coved downsloping ST segmentsSlightly peaked T-waves, most evident in V5-6Together, these features make this ECG consistent only with hyperkalemia or another toxic/metabolic abnormality such as Na channel blockade. Sometimes a patient with profound metabolic acidosis may have this pattern as well, generally in the context of profound metabolic intoxication, usually critically ill, with down time, peri-arrest, post-ROSC, etc. V1-V2 morphology would be consistent with Brudaga pattern, but this should generally be more isolated to V1-V3 and would not generally have findings in all leads as we see here.The differential of the ECG is short, and the most common, most rapidly deadly, and most treatable etiology is hyperkalemia.Now for some context:The patient was a male in his 30s with type 1 diabetes presenting with chest pain and RUQ abdominal pain. His fingerstick read " Hi " and he stated he couldn ' t remember if he took his insulin the night before. Vitals were within normal limits with tachycardia.The team recognized the ECG as possibly due to hyperkalemia, especially in the clinical context. Labs were not yet back.They gave 2 gm calcium gluconate, then recorded this ECG:The QRS is more narrow, however the peaked T-waves and Brugada morphology in V1-V2 persist.The team administered another 2 gm calcium gluc...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs