{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T07:21:32Z","timestamp":1783581692843,"version":"3.55.0"},"reference-count":10,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>Abstract:<\/jats:title>\n                  <jats:p>Electrolyte abnormalities may masquerade as acute neurological or cardiac emergencies in the emergency department (ED). In such atypical presentations, a timely bedside electrocardiography (ECG) often provides the earliest and most critical clue, facilitating an accurate diagnosis, guiding appropriate management, and improving patient outcomes. A 32-year-old male presented with rapidly evolving flaccid quadriparesis without sensory or autonomic involvement. A bedside ECG provided a critical clue, revealing a Mobitz type I block with ischemia-mimicking ST\u2013T changes and prominent U waves. This prompted urgent testing, which confirmed profound hypokalemia and hypomagnesemia. Swift intravenous repletion reversed both paralysis and conduction abnormalities within 72 h. Although electrolyte abnormalities are known to produce typical ECG changes, their presentation with conduction disturbances such as Wenckebach block is rare and easily misinterpreted as ischemia or structural heart disease. Prompt recognition of these atypical ECG findings at the bedside is critical to avoid unnecessary invasive workups and to initiate lifesaving electrolyte correction.<\/jats:p>","DOI":"10.4103\/tjem.tjem_427_25","type":"journal-article","created":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T07:01:54Z","timestamp":1783580514000},"page":"252-255","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["A patient with acute quadriparesis in the emergency department: Unmasking the diagnosis through electrocardiography"],"prefix":"10.4103","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-9471-3779","authenticated-orcid":false,"given":"Anukarthika","family":"Somasundaram","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine and Trauma, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4157-2844","authenticated-orcid":false,"given":"M. Mari Selva","family":"Ganesh","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine and Trauma, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6410-2896","authenticated-orcid":false,"given":"V. T.","family":"Amrithanand","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine and Trauma, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,7,9]]},"reference":[{"key":"R1-20260709","doi-asserted-by":"crossref","first-page":"73","DOI":"10.15441\/ceem.16.194","article-title":"A retrospective study of emergency department potassium disturbances: Severity, treatment, and outcomes","volume":"4","author":"Singer","year":"2017","journal-title":"Clin Exp Emerg Med"},{"key":"R2-20260709","doi-asserted-by":"crossref","first-page":"1535","DOI":"10.1093\/eurheartj\/ehy100","article-title":"Serum potassium and adverse outcomes across the range of kidney function: A CKD prognosis consortium meta-analysis","volume":"39","author":"Kovesdy","year":"2018","journal-title":"Eur Heart J"},{"key":"R3-20260709","doi-asserted-by":"crossref","first-page":"e594","DOI":"10.1002\/hsr2.594","article-title":"Severe hypokalemia in the emergency department: A retrospective, single-center study","volume":"5","author":"Makinouchi","year":"2022","journal-title":"Health Sci Rep"},{"key":"R4-20260709","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1016\/j.jemermed.2004.04.006","article-title":"Electrocardiographic manifestations: Electrolyte abnormalities","volume":"27","author":"Diercks","year":"2004","journal-title":"J Emerg Med"},{"key":"R5-20260709","doi-asserted-by":"crossref","first-page":"300060518811058","DOI":"10.1177\/0300060518811058","article-title":"Electrocardiographic manifestations in severe hypokalemia","volume":"48","author":"Wang","year":"2020","journal-title":"J Int Med Res"},{"key":"R6-20260709","first-page":"236","article-title":"Severe hypokalemia masquerading myocardial ischemia","volume":"3","author":"Petrov","year":"2012","journal-title":"Cardiol Res"},{"key":"R7-20260709","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1111\/j.0954-6820.1982.tb03164.x","article-title":"A hypokalemic index ECG as a predictor of hypokalemia","volume":"212","author":"Johansson","year":"1982","journal-title":"Acta Med Scand"},{"key":"R8-20260709","doi-asserted-by":"crossref","first-page":"1616","DOI":"10.1378\/chest.105.5.1616","article-title":"Hypokalemia associated with infra-His Mobitz type second degree A-V block","volume":"105","author":"Veress","year":"1994","journal-title":"Chest"},{"key":"R9-20260709","first-page":"63","article-title":"Hypokalemic periodic paralysis with arrhythmia. A case report and review of literature","volume":"6","author":"Shires","year":"1978","journal-title":"J Fam Pract"},{"key":"R10-20260709","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1159\/000479802","article-title":"Association of serum potassium with all-cause mortality in patients with and without heart failure, chronic kidney disease, and\/or diabetes","volume":"46","author":"Collins","year":"2017","journal-title":"Am J Nephrol"}],"container-title":["Turkish Journal of Emergency Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.lww.com\/10.4103\/tjem.tjem_427_25","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T07:01:56Z","timestamp":1783580516000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/10.4103\/tjem.tjem_427_25"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7]]},"references-count":10,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.4103\/tjem.tjem_427_25","relation":{},"ISSN":["2452-2473","2452-2473"],"issn-type":[{"value":"2452-2473","type":"print"},{"value":"2452-2473","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7]]},"assertion":[{"value":"2025-11-01","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-02-04","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}