EKG Rhythm Strips: Hyperkalemia part 1
Hyperkalemia ECG changes
Table 2 —ECG findings in hyperkalemia1
Moderate* Loss of P waves
Severe Bizarre widening of QRS complex
· Flattened or absent P waves
· Prolonged PR interval
· Widened QRS complex
· Peaked (widened base, narrow peaks) or elevated T waves
· ST depression
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
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
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