EKG Rhythm Strips: Hyperkalemia part 1

Hyperkalemia ECG changes

·         Flattened or absent P waves

·         Prolonged PR interval

·         Widened QRS complex

·         Peaked (widened base, narrow peaks) or elevated T waves

·         ST depression

 Table 2 —ECG findings in hyperkalemia¹

Severity                               Findings

Mild to moderate

                    Peaked, “tented” T waves

                    Flattening of P waves

Moderate*                         Loss of P waves

                                           Increased PR interval

                                           Uniform widening of QRS complex

                                           Nodal rhythm

Severe                                Bizarre widening of QRS complex

                                           Sine wave

                                           Ventricular fibrillation

                                           Asystole

*There is no clear correlation between levels of potassium and the likelihood of an arrhythmia; however, arrhythmia is more likely if the increase in potassium is rapid.

²Treatment                                         Purpose

Regular insulin                                  Facilitates the entry of glucose into the cell

D50                                                    Together with insulin shifts potassium into cell

Calcium chloride                              Antagonizes cardiac conduction abnormalities due to hyperkalemia

Calcium gluconate                           Antagonizes cardiac conduction abnormalities due to hyperkalemia

Polystyrene sulfonate                      Exchanges sodium for potassium in the gut

Lasix                                                Excretion of potassium by the kidney                                    

Sodium Bicarbonate                        Temporary shift of potassium into the cell

Albuterol nebulization                     Facilitates the shift of the extra-cellular potassium into the cell

¹Consultant Live

ECG Changes in Hyperkalemia

By SARA LASKEY, MD JANET POPONICK, MD | August 1, 2006

www.consultantlive.com/display/article/10162/40264

²An Acute Myocardial Infarction?

By Linda K. Cook, RN, PhD, CCRN, CCNS, ACNP-BC

American Journal of Critical Care. 2005;  14: 313-315

Hyperkalemia with serum potassium of 5.5mEq/L

Hyperkalemia with serum potassium of 5.5mEq/L

Mild to moderate ECG changes

Peaked T waves

Hyperkalemia with serum potassium of 5.7mEq/L

Hyperkalemia with serum potassium of 5.7mEq/L

Mild to moderate ECG changes

Peaked T waves

Hyperkalemia with serum potassium of 6.0mEq/L

Hyperkalemia with serum potassium of 6.0mEq/L

Moderate ECG changes

Decreased amplitude of P waves

Prolonged PR interval

Uniform widening of QRS complex

Peaked T waves

Reviewed 3/1/16