Hyperkalemia

Definition

Serum potassium > 5.5mEq/L, associated with lethal arrhythmias and hemodynamic compromise.

History/Physical Exam

Hx of renal failure, rhabdomyolysis, burns, potassium-sparing diuretics, NSAIDs, β-blockers.

Often presents with fatigue, weakness, or paresthesia.  May present with paralysis, dyspnea, or chest pain.

Key 12-Lead Features

Flattened P waves, prolonged PR intervals, borderline widened QRS complexes and pointed, narrow, and tall tented T waves.

May progress to bradycardia, bizarre and wide QRS complexes, or sine waves.

Key Treatment Points

If patient is in arrest, front-load with Calcium Chloride and Sodium Bicarbonate 
Salbutamol - 10-20mg nebulized may reduce serum K+ 0.5-1.5mEq

12 Lead ECG Samples

Further Reading

References

Heidari, S. F. (2016). Life-Threatening Severe Hyperkalemia Presenting Electrocardiographic Changes. Journal of Intensive and Critical Care, 02(03). doi:10.21767/2471-8505.100045.