• Marion G Borgstede, Majoline J W van den Broeke-Vos, Renate Stevens-Stolmeijer, and Heleen Lameijer.
• Department of Emergency Medicine, Medical Centre Leeuwarden, Leeuwarden, The Netherlands.
• Emerg Med J. 2019 Jan 1; 36 (1): 51-60.

Clinical IntroductionA 56-year-old man without known medical history was brought to our ED after he was found next to his bed, agitated and with waxing and waning consciousness. He has been bedbound for 5 days after a long-standing period of malnutrition. Physical examination reveals Kussmaul breathing, heart rate of 62/min and blood pressure of 135/100 mm Hg, normal cardiac, abdominal and a non-focal neurological examination other than confusion and altered level of consciousness. An EKG was performed (figure 1).emermed;36/1/51/F1F1F1Figure 1EKG at presentation in our ED.QuestionWhat abnormalities are the clues to the severity of his condition? How would you confirm your suspicion?The minimally prolonged QTc time.The subtle horizontal ST segment elevation in V2 and V3.The subtle positive deflection at the J point.Nothing, this EKG is not interpretable because of the movement of baseline.© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2019. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

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