Science and Education Publishing American Journal of Medical Case Reports 2 12 2014 11 25 Compartment Syndrome and Rhabdomyolysis Presenting with the Rare Pseudo-Infarction Pattern of Hyperkalemia 262 265 EN Richard Pescatore Department of Emergency Medicine, Cooper University Hospital, Camden, NJ USA Mark Robidoux Robert Cole Brett Waldman Catherine Ginty AJMCR20142121 10.12691/ajmcr-2-12-1 2014 10 29 2014 11 19 2014 11 25 The rapid identification and treatment of patients with ST-segment elevation myocardial infarction (STEMI) is a priority for emergency department providers. Occasionally conditions other than acute coronary syndrome (ACS) can mimic the presence of ST-elevation on electrocardiogram (ECG), making the accurate identification of these patients challenging. We present a case in which severe metabolic derangements resulted in a rare pseudo-STEMI pattern on ECG. A 26 year old male was found at home by family after a reported fall. A pre-hospital ECG conducted by EMS personnel indicated STEMI and the cardiac catheterization team was activated prior to patient arrival. Before undergoing PCI, laboratory values revealed severe hyperkalemia and rhabdomyolysis. Treatment of the patient's hyperkalemia resulted in resolution of ECG abnormalities. The patient later developed acute compartment syndrome and underwent emergent fasciotomy. This case demonstrates the rare pseudo-infarction pattern of hyperkalemia and underscores the importance of clinical context in the initial evaluation of the emergency patient.