Answer to Quiz 1:

ECG shows: a wide complex rhythm – with a sine-wave configuration – is sinoventricular rhythm.

Diagnosis: Hyperkalemia

More abt hyperkalemia:

Hyperkalemia is a common life-threatening metabolic emergency. It is most often diagnosed in patients with renal failure.

Hyperkalemia may present with lethargy and weakness as the sole manifestation; alternatively, the patient may demonstrate significant ECG abnormality in addition to the mental status and constitutional signs.

Pathophysiologically, increasing potassium levels are associated with depressed electrical conduction. Significant variation is noted with respect to serum potassium levels and clinical manifestation; in general, sudden or rapid increases in the serum potassium concentration are associated with earlier development of clinical illness, including ECG abnormalities. However, the relationship between potassium levels and ECG changes may vary between different patients.

K+ level = 5.5–6.5 mEq/L: Prominent T-wave; Tall, narrow, symmetric; Most prominent in precordial leads

K+ level = 6.5–8.0 mEq/L: Decreased P-wave amplitude; Prolonged PR interval; Prominent T-wave; QRS complex widening (minimal to sine-wave configuration); Dysrhythmia; Atrioventricular block; Intraventricular block; Bradycardia; Ventricular ectopy.

K+ level more than 8.0 mEq/L: Sinoventricular rhythm; Absence of P-wave; QRS complex widening, progressing to sine-wave QRS complex; Ventricular tachycardia; Ventricular fibrillation; Asystole.

The goals of therapy are a reduction of the serum potassium level coupled with a stabilization of the myocardial cell membrane.

The management of hyperkalemia includes therapies aimed at the stabilization of the myocardium (Calcium), temporary shifting of the excess potassium intracellularly (dextrose, insulin, beta-adrenergic agonists, magnesium, and sodium bicarbonate), and ultimate removal of the potassium from the body (gastrointestinal binding resins and hemodialysis).

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