Hyperkalæmia

Report:

Sinus rhythm

ST/T changes consistent with hyperkalæmia

Comment:

The T waves are peaked, tall and narrow, tent-shaped with soupçon of a waist – typical of hyperkalæmia. The ST segments are elevated in several leads, reflecting the dialyzable current of injury120 of Levine’s. The QRS complex is only 0.10” in duration, but has acquired characteristic S waves in 1 and V6 compared to normal baseline ECG (Fig 164a below). Also compared to baseline, the P waves appear flattened.

A more advanced hyperkalæmia is shown in Fig 164b, at potassium level of 8.0 mEq/L.

The patient had intractable rhabdomyolysis and hæmolysis and the potassium level remained high despite dialysis with two hæmodialysis machines; he died within the ensuing 14 hours. The country hospital where he was originally admitted had only a single dose of tiger snake antivenine and much time was lost before he reached Canberra.

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