Article Text

Download PDFPDF
When the factory shuts down
  1. Marion G Borgstede,
  2. Majoline J W van den Broeke-Vos,
  3. Renate Stevens-Stolmeijer,
  4. Heleen Lameijer
  1. Department of Emergency Medicine, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
  1. Correspondence to Dr Heleen Lameijer, Department of Emergency Medicine, Medical Centre Leeuwarden, Leeuwarden 8934 AD, The Netherlands; h.lameijer{at}


Clinical introduction A 56-year-old man without known medical history was brought to our ED after he was found next to his bed, agitated and with waxing and waning consciousness. He has been bedbound for 5 days after a long-standing period of malnutrition. Physical examination reveals Kussmaul breathing, heart rate of 62/min and blood pressure of 135/100 mm Hg, normal cardiac, abdominal and a non-focal neurological examination other than confusion and altered level of consciousness. An EKG was performed (figure 1).

Figure 1

EKG at presentation in our ED.

Question What abnormalities are the clues to the severity of his condition? How would you confirm your suspicion?

  1. The minimally prolonged QTc time.

  2. The subtle horizontal ST segment elevation in V2 and V3.

  3. The subtle positive deflection at the J point.

  4. Nothing, this EKG is not interpretable because of the movement of baseline.


  • Osborn waves
  • J-waves
  • hypothermia
  • diabetes mellitus
  • diabetic ketoacidosis

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.