Hyperkalæmia: IVCD

Report:

Broad complex rhythm of uncertain origin 68/min.

Possible sinoventricular conduction with intraventricular conduction defect.

Peaked T waves.

Trace suggestive of hyperkalæmia.

Comment:

The absent P waves, widened QRS and the tall, peaked T waves are very suggestive of hyperkalæmia. Serum potassium was 8.0 mEq/L.

Further progression would have shown QRS merging with the T wave and eventual VF.

The sinoventricular conduction takes place at K+ levels 7.5 mEq/L and above despite atrial (muscle) paralysis: the internodal tracts are more resistant to hyperkalæmia. Still, there is no way of excluding an accelerated junctional or even idioventricular rhythm in this situation. The treatment is the same.

The ECG normalised overnight (Fig 230 below).

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