Torsades de Pointes Secondary to Respiratory Failure and GTCS

We report the case of a 46-year-old male who presented to the emergency department (ED) in critical condition. He was found unresponsive, tachypneic, and with signs of severe respiratory distress, with both airway patency and breathing severely compromised. Due to his unstable clinical status, immediate intubation was performed to secure the airway and provide adequate ventilation. An initial electrocardiogram (ECG) revealed ventricular tachycardia with the classic morphology of Torsades de Pointes (TdP), characterized by a twisting QRS axis around the baseline. This polymorphic ventricular tachycardia is often life-threatening and required urgent intervention to prevent progression to ventricular fibrillation. Alongside the ECG findings, arterial blood gas (ABG) analysis showed severe respiratory alkalosis, with a markedly elevated pH of 7.64, suggesting significant hyperventilation. Notably, there was also evidence of a concurrent metabolic acidosis, with a bicarbonate (HCO₃⁻) level of 7.2 mmol/L, indicating a mixed acid-base disturbance likely exacerbated by underlying physiological stressors. This case also serves as a reminder that in patients with seizure disorders and multiple metabolic imbalances, clinicians should remain vigilant for arrhythmia like TdP to prevent life-threatening outcomes.