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A 68-year-old woman with pancreatic cancer undergoing chemotherapy presented to the emergency department with a week of vomiting and body cramps. Vital signs were: BP 130/70 mm Hg; HR 80 bpm; RR 14 bpm and oxygen saturation 100% while breathing ambient air. Laboratory investigations showed normal calcium, magnesium and albumin levels; hypokalaemia level at 2.3 mmol/L (normal range 3.5–5.0 mmol/L) and bicarbonate level at 42 mmol/L (normal range 22–29 mmol/L).
While the nurse was taking …
Contributors HY and FD contributed equally to the diagnosis, management of patient and to the writing of this ‘image challenge’.
Competing interests None.
Patient consent Obtained.
Provenance and peer review Not commissioned; internally peer reviewed.