Perhaps this belongs in cardiology first, but wanted to run it by here. Had a patient today, presents with a good hypoglycemic fall story. Type I DM in his 50s (hx 2 MIs), woke up sweaty and weak, goes to shower, goes AMS per gf, falls, breaks 4 ribs, is given sugar at home, fs 35, regains mental status, gets more glucose in ambulance ride over and then I see him. Has a bit of fluid behind one of his lungs, so we have him drink contrast for a CT. I come back and check in on him. Cold, sweating up a storm, weak, lethargic. Gets D50, we check fs afterwards and it's in 300s. Assume it's another hypoglycemic episode since he took his lantus in the AM and didn't eat. But he's slow coming around, and is still lethargic an hour later. So here's the mystery: I check his EKG, 6 hours earlier - normal, now - he has a RBBB, with maybe a T-wave flattening in V2, and maybe left atrial enlargement (whichever one produces wide p waves). He's ticking away at 60bpm, no CP, no worsening SoB. Anyone have any idea whatsup?