A 27-year-old woman with hypertension, type 1 diabetes mellitus, and end-stage renal disease presents to an outpatient renal clinic complaining of generalized weakness. She missed her last dialysis session 2 days earlier.
She appears alert when stimulated but is otherwise lethargic. Heart rate is 70 beats per minute; respiration rate, 28 breaths per minute; blood pressure, 100/70 mm Hg; and oxygen saturation, 93% on room air. Bibasilar rales are audible on auscultation.
Laboratory studies, a chest radiograph, and a 12-lead ECG are ordered. The rhythm strip and the 12-lead ECG are shown here.
What diagnosis do the ECG findings suggest?
(Answer and discussion begin on next page.)
