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Symptoms: Weakness and Muscle Cramps

Chan, Theodore MD; Brady, William MD; Harrigan, Richard MD

Cases in Electrocardiography

Dr. Chan is an associate professor of clinical medicine, emergency medicine, the director of CQI, and the associate medical director of the department of emergency medicine at the University of California

San Diego; and Dr. Brady is an associate professor and the program director in the department of emergency medicine at the University of Virginia School of Medicine in Charlottesville.

Dr. Harrigan is an associate professor of emergency medicine and the associate research director in the department of emergency medicine at Temple University Hospital and School of Medicine in Philadelphia

A 24-year-old woman with a history of type 1 renal tubular acidosis presented to the emergency department complaining of two days of headache, generalized weakness, and diffuse muscle cramping. The patient also noted the onset of nausea and vomiting over the past day.

She denied any chest pain, palpitations, shortness of breath, respiratory difficulty, cough, fevers, chills, diarrhea, or urinary complaints. At triage, her temperature was 97.1°F, pulse 71 bpm, blood pressure 98/68 mm Hg, and respiratory rate of 18 bpm.

Her examination revealed a non-toxic appearing young woman in no acute distress. Her pulmonary and cardiac examinations were unremarkable. On neurologic exam, she demonstrated intact sensation and motor strength, but had a slow gait. Given her nonspecific complaints, an ECG was obtained.

What is your diagnosis? See p. 26

© 2003 Lippincott Williams & Wilkins, Inc.