Abstract

Tombstone ST elevation in the electrocardiogram (ECG) is an ominous marker of high-risk ST-elevation myocardial infarction (STEMI), but occasionally, it can be caused by severe, noncardiac conditions. A woman in her early 20s was hospitalized after intentional overdose of ibuprofen. An empty box of ibuprofen was found at the bedside, but it was unknown exactly how many pills the patient had taken. On presentation, she was unresponsive, hypothermic, and had severe metabolic acidosis. Alcohol, salicylate, and acetaminophen levels were negative.

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