Case Report: Older Woman with 6 Days of Vomiting and Diarrhea

January 22, 2021
Brady Pregerson, MD

Check out our latest case report from Dr. Brady Pregerson, which features a smoker in her 60 with a history of COPD presenting with 6 days of vomiting and diarrhea and 1 day of constant LLQ pain. Can you determine the correct diagnosis?

History: A woman in her 60’s with a history of COPD (who still smokes) presents to the ED for 6 days of vomiting and diarrhea and 1 day of constant LLQ pain. She denies fever, bleeding, recent travel or antibiotic use, chest pain, SOB that is any worse than her usual baseline or any other complaints.

Exam: Vital signs are normal except for a pulse ox of 92% on room air, which she thinks may be normal for her and a temperature of 99.4. Exam is remarkable for diffuse abdominal tenderness without rebound that is more pronounced on the left than on the right.

An EKG is done:

Computer Read:

  • NSR at 86 with PR 152ms, QRS or 84ms and QTc 379ms
  • Low voltage in precordial leads
  • Possible anterior MI, probably old

What is the most likely cause of the EKG findings?

A) Hyperkalemia

B) Hypokalemia

C) Hypomagnesemia

D) ACS