Saturday, May 20, 2017

A 63 year old with Hyperkalemia (potassium 7.4mEq/L) and a Paced Rhythm

A defining characteristic of hyperkalemia on an EKG is a tall, tented T wave.  The T wave is peaked at the top and broader at the base.  When the hyperkalemia is more profound, the QRS complex tends to widened and fuse with the T wave forming a sine wave.

The rhythm looks regular due to pacemaker.  The pacing rate is about 100 bpm.  There appears to be a first degree block.  Upright P waves are seen in the continuous lead II strip at the bottom.  

The patient was treated initially with calcium gluconate, IV insulin, and 50% dextrose.  She is a hemodialysis patient and underwent urgent hemodialysis. 

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