Hyperkalemia, electrocardiography, electrolytes. Pseudohyperkalemia refers to artificially elevated potassium due to: (a) Hemolysis. Hyperkalemia is variably defined as potassium >5.5 mM or >5.0 mM, depending on the source. After reviewing the case, one should recognize the importance of the ECG for screening and prompt treatment of electrolyte derangements, understand the acute management of hyperkalemia, and appreciate the possibility for rapid deterioration. There should always be a high suspicion for hyperkalemia in any bradycardic patient, especially if there are other EKG findings to suggest hyperkalemia.

While the outcome was unfortunate, it also highlights the temporal relationship between the presented ECG findings and fatal arrhythmias. Unfortunately, during aggressive initial management, the patient suffered a pulseless electrical activity cardiac arrest, and in accordance with his wishes no resuscitative efforts were performed. severity of hyperkalemia is not correlated with ECG findings, in the presence of ECG findings. Ultimately the patient was confirmed to have a severely elevated potassium level of eight mmol/L. Delay in the treatment of hyperkalemia may lead to life. His treatment consisted of cardiac stabilization with calcium, followed by efforts to shift potassium intracellularly with insulin and beta-agonists. Findings on initial ECG allowed for rapid diagnosis and treatment before serum potassium levels were confirmed. Hyperkalemia related ECG changes are more likely to be severe and progressive in the setting of concurrent occurrence of metabolic acidosis, hypocalcemia, and hyponatremia. A 78-year-old male with history of end stage renal disease presented with chest pain. Severe hyperkalemia, in rare circumstances, can be associated with minimal ECG findings lacking characteristic hyperkalemia related features or even normal ECG.

It also emphasizes the importance of the ECG in screening for electrolyte abnormalities and the ability to begin therapy before laboratory confirmation in the correct clinical setting. 2009 339:b4114.This case highlights the classic electrocardiogram (ECG) finding of a severely widened QRS complex with a sinusoidal pattern indicative of severe hyperkalemia. Cardiac arrest in special circumstances: Electrolyte abnormalities, poisoning, drowning, accidental hypothermia, hyperthermia, asthma, anaphylaxis, cardiac surgery, trauma, pregnancy, electrocution. European Resuscitation Council Guidelines for Resuscitation 2010 Section 8. Treatment of acute hyperkalaemia in adults ECG finding are neither specific nor sensitive for detecting hyperkalaemia (3).the longer a patient has high potassium concentrations, the greater the risk of sudden deterioration (1)Ĭlick here for an example ECG and further information.risk of arrhythmias increase with potassium values > 6.5 mmol/L and even small elevations in potassium above this concentration can lead to rapid progression from peaked T waves to ventricular fibrillation or asystole.Wide and Flat p-waves At this level, p-waves start to widen and flatter.

Serum Potassium level > 6.5 mEq/L At serum potassium levels greater than 6.5 mEq/L, the cardiac rhythm strip’s intervals and waves continue to lengthen, flatten and heart rate slows. cardiac arrest (pulseless electrical activity, ventricular fibrillation/pulseless ventricular tachycardia, asystole) (2)ĮCG changes with hyperkalaemia do not consistently follow a stepwise, dose-dependent pattern. Peaked T-waves are usually the first findings found on the ECG in the setting of hyperkalemia.The ECG is an important diagnostic tool in the early diagnosis of hyperkalemia as well as in the initiation of empiric treatment ( Table 2 ). arrythmias including bradycardia, ventricular tachycardia or fibrillation ecg findings in hyperkalemia Potassium has a significant effect on the myocardium and is a key determinant of the resting membrane potential of cells.S and T wave merging (sine wave pattern).first degree heart block (prolonged PR interval).Hyperkalaemia causes a rapid reduction in resting membrane potential leading to increased cardiac depolarization, and muscle excitability which in turn causes EG changes (1).ĮCG changes are usually progressive and may include:

Hyperkalemia ecg findings