Hyperkalæmia

Report:

Sinus rhythm 94/min

Intraventricular conduction delay (IVCD)

QRS 0.14”

Peaked T waves, possible hyperkalæmia

Comment:

Patients arresting in dialysis units are invariably treated for hyperkalæmia. On arrival to ICU, the potassium level was only 7.5 mEq/L, reflected here in the IVCD and peaked T waves. The IVCD is usually seen at levels higher than 7.5 mEq/L, but one can safely assume that they were very high at the time of the arrest. The rate of rise affects the ECG manifestations of hyperkalæmia19; perhaps this is also is true of he rate of fall. These normalised with further therapy (Fig 14a). What remained was a pre-existing LAHB and nonspecific ST/T changes.

ECG is particularly unreliable tool for detecting or quantifying hyperkalæmia in dialysis patients20, where it’s most needed.

The patient had end-stage renal failure from IgA nephropathy, complicated by tertiary hyperparathyroidism and congestive cardiomyopathy. The latter has an uncertain aetiology21. He survived this admission to ICU but died a few months later.