Ramy Saleh, DO; Robert Bassett, DO; Alan Lucerna, DO; Wayne Tamaska, DO; James Espinosa, MD; Kumail Kazim; Frederick Barnum IV; Emeka EzidiegwuThe patient's Glasgow Coma Scale score on presentation was 15/15, and his vital signs were as follows:Respiratory rate: 18 breaths/minECG revealed a prolonged QTc of 507 msec . His serum potassium level was 3.1 mmol/L .
Physical examination findings included a soft, nondistended abdomen with unspecified diffuse abdominal tenderness to palpation and positive bowel sounds in all four quadrants. The findings were otherwise unremarkable. A toxicology consult was immediately obtained. Recommendations included placement of a nasogastric tube, 1 g/kg of activated charcoal, and whole-bowel irrigation with polyethylene glycol solution at 1.5-2 L/hr via nasogastric tube until rectal effluent was clear. Potassium supplementation was initiated, targeting a serum level of 3.5-4 mmol/L. During this time, serial ECGs were performed to monitor the QRS and QTc intervals in particular.
Two hours after arrival, the patient exhibited approximately 15 seconds of generalized seizure activity, followed by polymorphic
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