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

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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