This patient has a severe electrolyte abnormality. Can you tell what it is? (Not hypokalemia)

This patient has a severe electrolyte abnormality.  Can you tell from the ECG what it is?IMPRESSION by computer and physician overread:Heart Rate 120SINUS TACHYCARDIA WITH FIRST DEGREE AV BLOCKPOSSIBLE LEFT ATRIAL ENLARGEMENT [-0.1mV P WAVE IN V1/V2]MODERATE ST DEPRESSION [0.05+ mV ST DEPRESSION]Prolonged QTABNORMAL ECGP-R Interval 220 msQRS Interval 84 msQT Interval 349 ms QTC Interval 419 msP Axis 125QRS Axis 13T Wave Axis 2I think the computer got the QT wrong.  It is at least 360 ms and possibly as high as 400 ms.Hodges Corrections using 360 ms: QTc = 465 msSmith Impression: The ECG shows sinus tachycardia, some prolongation of the QT interval, and ST depression.  None of these findings are specific to this patient ' s severe hypernatremia.  With ST depression, one must entertain hypokalemia as well as ischemia, but the K was normal.Clinical History and Lab data:This patient complained of diarrhea, and attempted to treat his diarrhea with homemade electrolyte solution.  He presented with altered mental status and his Na = 175 mmol/L.  Other electrolytes were normal.His troponin was modestly elevated and the ST depression is probably due to demand ischemia.I don ' t believe you can make the diagnosis from the ECG.None of the findings on the ECG are attributable to hypernatremia.  As far as I can tell, there are no typical ECG findings in the context of severe hypernatremia.  One might guess that high extracellular...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs