ECG Rhythm Strips 82: Hyperkalemia

1.

Hyperkalemia

2.

Hyperkalemia 5.5mEq/L

3.

Hyperkalemia 6.0mEq/L

4.

Hyperkalemia 6.4mEq/L

5.

Hyperkalemia 7.1mEq/L

6.

Hyperkalemia 7.0mEq/L

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