The great imitator: Hyperkalemia presenting with paralysis and ST segment elevations

We report the case of a 75-year-old man with a history of hypertension, gout, type 2 diabetes, ileostomy from diverticulitis, and surgery one month prior for an intra-abdominal abscess who presented to the emergency department with shoulder pain and weakness of the upper and lower extremities, worse on the right. Given the lateralizing extremity weakness, a stroke was initially suspected.In addition, he was found to have anteroseptal and inferior ST segment elevations on his EKG which were concerning for an ST segment elevation myocardial infarction (STEMI). He was ultimately found to have neither stroke nor acute coronary syndrome, but instead, he had a rare and potentially lethal complication of an electrolyte disorder.