Marked Symptomatic Bradycardia Associated with Profound Hyperkalemia (original) (raw)
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Journal of Clinical Cardiology and Cardiovascular Interventions, 2020
Bradycardia is commonly encountered in emergency department. Hyperkalemia may sometime cause bradycardia with block and also synergize with AV node blockers to cause bradycardia and hypoperfusion. We report a 53 years old male with history of hypertension, congestive heart failure and coronary artery disease was admitted to hospital for sudden onset of breathlessness. He underwent percutaneous coronary intervention (PCI) to left anterior descending (LAD) artery and left circumflex (LCx) artery one year ago and taking Aspilet 80 mg for daily, Clopidogrel 75 mg daily, Ramipril 5 mg daily, Atorvastatin 20 mg daily, Metoprolol 25 mg daily, Spironolactone 25 mg daily and Frusemide 40 mg daily. Significant physical examination was remarkable for a temperature 97.5'F, blood pressure of 110/70 mmHg, heart rate of 40 beats per minute, oxygen saturation was 99% on air and both lung were full with audible crepitation by auscultation. He was given atropine 0.6 mg bolus and transcutanaeous pacing with unimproved heart rate and then a transvenous pacing was immediately placed before the blood investigation results were returned. His relevant laboratory values were significant for a potassium of 7.99 mmol/L(ref range : 3.5-5.2 mmo/l) , creatinine of 458 micmol/L (ref range : 59-104 micmol/L) , Urea of 33.9 mmol/L (ref range : 2.7-8.0 mmol/l), random blood glucose of 233mg/dl , sodium 126.8 mmol/L (ref range 135-145 mmol/L) , anion gap of 13.5 mmol/? (ref range : 3.6-11.0 mmo/L) and bicarbonate of 15.6 mmil/L (ref range: 22-29 mmol/L). He was given calcium glucoronate , insulin with dextrose , kaexylate , nebulizer salbutamol with significant improvement in his potassium levels to 4.6 in 24 hours. In Cardiac intensive care unit his heart rate was improved and the transvenous pacemaker was turned off the next day.
International Journal of Medical Science and Public Health, 2017
Insulin, catecholamines, and acid-base balance affect to move potassium into the cells. 90% of the potassium is excreted from the kidney. Therefore, renal function is important in ensuring the potassium balance. [1-4] Hyperkalemia is defined as a serum potassium concentration above 5.0 mmol/l. [4] Potassium ≥10 mEq/L is often fatal. [5] Clinical findings of hyperkalemia depend on electrophysiological distortion. In hyperkalemic state, cardiac effects of potassium occur due to the cell membrane depolarization. Hyperkalemia slows the ventricular neurotransmission. [1,2,6] Background: Hyperkalemia is the life-threatening problem. Early diagnosis and treatment of patients with the possibility of hyperkalemia should be performed in emergency department. Comorbid diseases used medications and electrocardiography (ECG) findings can be important clues for the possibility of hyperkalemic states. Objectives: In our study, we aimed to identify causes of hyperkalemia in patients who admitted to emergency department and to evaluate the importance of the relationship between hyperkalemia and ECG. Materials and Methods: Our study desing was prospective. The patients who admitted to emergency department which has annual turnover of 70,000 patients between June 01, 2012, and June 01, 2014, were investigated. Total 100 patients aged 18 years and above who had hyperkalemia were included in the study. Patients were divided into three groups according to the level of potassium (1-mild: 5-5.9 mEq/L, 2-moderate: 6-7 mEq/L, 3-severe: >7 meq/L) and ECG finding of these hyperkalemic patients were evaluated. Patients were categorized according to etiology of hyperkalemia in four groups. They are chronic renal failure (CRF), acute renal failure (ARF), (angiotensinconverting-enzyme inhibitor /angiotensin-receptor blocker (ACEI/ARB) use and spironolactone use. Results: In our study, we included 100 patients with hyperkalemia. Potassium value of patients was maximum 8.1 mEq/L and mean value was 6.12 +/− 0.66 mEq/L. There was no significant correlation between the ECG and potassium level (P = 0.107). In our study, we found that the most contributing cause was CRF, the second was ARF and the third was ACEI/ARB +/− spironolactone. Conclusions: According to our study, it should be kept in mind that even if the ECG findings are normal, hyperkalemia may occur in patients with ARF, CRF, spironolactone, and ACEI/ARB drug users.
ECG alterations suggestive of hyperkalemia in normokalemic versus hyperkalemic patients
BMC Emergency Medicine
Background: In periarrest situations and during resuscitation it is essential to rule out reversible causes. Hyperkalemia is one of the most common, reversible causes of periarrest situations. Typical electrocardiogram (ECG) alterations may indicate hyperkalemia. The aim of our study was to compare the prevalence of ECG alterations suggestive of hyperkalemia in normokalemic and hyperkalemic patients. Methods: 170 patients with normal potassium (K +) levels and 135 patients with moderate (serum K + = 6.0-7.0 mmol/l) or severe (K + > 7.0 mmol/l) hyperkalemia, admitted to the Department of Emergency Medicine at the Somogy County Kaposi Mór General Hospital, were selected for this retrospective, cross-sectional study. ECG obtained upon admission were analyzed by two emergency physicians, independently, blinded to the objectives of the study. Statistical analysis was performed using SPSS22 software. χ 2 test and Fischer exact tests were applied. Results: 24% of normokalemic patients and 46% of patients with elevated potassium levels had some kind of ECG alteration suggestive of hyperkalemia. Wide QRS (31.6%), peaked T-waves (18.4%), Ist degree AV-block (18.4%) and bradycardia (18.4%) were the most common and significantly more frequent ECG alterations suggestive of hyperkalemia in severely hyperkalemic patients compared with normokalemic patients (8.2, 4.7, 7.1 and 6.5%, respectively). There was no significant difference between the frequency of ECG alterations suggestive of hyperkalemia in normokalemic and moderately hyperkalemic patients. Upon examining ECG alterations not typically associated with hyperkalemia, we found that prolonged QTc was the only ECG alteration which was significantly more prevalent in both patients with moderate (17.5%) and severe hyperkalemia (21.1%) compared to patients with normokalemia (5.3%). Conclusions: A minority of patients with normal potassium levels may also exhibit ECG alterations considered to be suggestive of hyperkalemia, while more than half of the patients with hyperkalemia do not have ECG alterations suggesting hyperkalemia. These results imply that treatment of hyperkalemia in the prehospital setting should be initiated with caution. Multiple ECG alterations, however, should draw attention to potentially life threatening conditions.
Cardiac Manifestations in a Case of Severe Hyperkalemia
Cureus, 2021
Severe hyperkalemia is a life-threatening electrolyte imbalance that may lead to fatal arrhythmias. ECG (electrocardiogram) and serum potassium levels are vital for diagnosing and stratifying the risk. Management involves shifting potassium intracellularly and eliminating it through renal and gastrointestinal routes. Failure to diagnose early and manage severe hyperkalemia requires emergent hemodialysis.
Severe hyperkalemia with minimal electrocardiographic manifestations
Journal of Electrocardiology, 1999
Severe hyperkalemia with minimal or nonspecific electrocardiographic (ECG) changes is unusual. We report data on seven patients with renal failure, metabolic acidosis, and severe hyperkalemia (K + -> 8 mmol/L) without typical ECG changes. Initial ECGs revealed sinus rhythm and PR and QT intervals in the normal range. QRS intervals were slightly prolonged in two patients (110 ms), and incomplete right bundle branch block was evident in one. Thus, the absence of typical ECG changes does not preclude severe hyperkalemia.
Hyperkalemia in Hospitalized Patients
Archives of Internal Medicine, 1998
Background: Hyperkalemia is a common, potentially life-threatening disorder. Electrocardiograms are con- sidered to be sensitive indicators of the presence of hy- perkalemia. Since the treatment of hyperkalemia in- volves relatively few maneuvers and because its success can be objectively scored, we investigated how physi- cians manage this disorder and how successful their pre- scribed therapy is. We also sought to