Double Trouble of Severe Hyperkalemia: Syncope and No Significant ECG Changes

MANAGEMENT OF SEVERE HYPERKALEMIA

Warning: The ECG May Be Normal in Severe Hyperkalemia

A 77-year-old man with chronic kidney disease was admitted to our hospital due to acute kidney injury and hyperkalemia (serum potassium, 8.5 mEq/L) with a normal ECG finding (Picture 1). Hyperkalemia was caused by tumor lysis syndrome from gastric cancer and medications, including enalapril, carvedilol, and spironolactone. His hyperkalemia improved following the discontinuation of these medicat...

Retrospective review of the frequency of ECG changes in hyperkalemia.

BACKGROUND AND OBJECTIVES Experimentally elevated potassium causes a clear pattern of electrocardiographic changes, but, clinically, the reliability of this pattern is unclear. Case reports suggest patients with renal insufficiency may have no electrocardiographic changes despite markedly elevated serum potassium. In a prospective series, 46% of patients with hyperkalemia were noted to have ele...

ECG diagnosis: hyperkalemia.

Joel T Levis, MD, PhD, FACEP, FAAEM, is a Senior Emergency Physician at the Santa Clara Medical Center, and Clinical Instructor of Emergency Medicine (Surgery) at Stanford University. He is the Medical Director for the Foothill College Paramedic Program in Los Altos, CA. E-mail: [email protected]. Figure 1. 12-lead ECG from an 82-year-old man with acute renal failure and hyperkalemia (serum pot...

Hyperkalemia and severe rhabdomyolysis

A 47-year-old homeless man with a history of bipolar disorder and polysubstance abuse was found under a bridge with altered mental status and severe left calf pain. Evaluation in the emergency department revealed a cachectic, pale man with a blood pressure of 132/84, pulse 74, and respirations 18. He was afebrile. Oxygen saturation was 98% on room air. Examination revealed marked swelling of th...