![]() ![]() Ī number of investigations have studied the correlation between elevated potassium levels and changes in the ECG. Reports about severe cases of hyperkalemia with none or minimal ECG alterations have also been published. According to earlier studies, the prevalence of ECG alterations in hyperkalemia was as low as 14–59% of the cases. ĭespite these ECG manifestations, the clinical diagnosis of hyperkalemia remains difficult as the electrophysiological disturbances listed above are not pathognomic of potassium disorders nor do they appear in each patient with hyperkalemia. Moderately elevated potassium levels (6.0–7.0 mmol/l) typically result in PR interval prolongation, decreased P wave amplitude, disappearance of the P wave, widening of the QRS complex or conduction blocks with escape beats, while severe hyperkalemia (> 7.0 mmol/l) may induce ventricular fibrillation and asystole on the ECG. Mildly elevated potassium levels (5.2–5.9 mmol/l) may cause tall T waves or peaked/tented T waves. As the level of serum potassium increases, typical ECG alterations appear in a characteristic sequence. The concentration of potassium in the serum is tightly regulated between 3.5 and 5.1 mmol/l. Since alterations in the ECG-s of patients with hyperkalemia have been documented in a number of investigations, ECG-s have been suggested to facilitate a non-invasive approach to diagnosing hyperkalemia. Although, portable devices are readily accessible in prehospital care to measure temperature, oxygen saturation and blood glucose levels, the diagnosis of hyperkalemia in prehospital settings is currently not possible. According to the European Resuscitation Council electrolyte disturbances, such as hypo- and hyperkalemia should be corrected preferably before cardiac arrest happens. In periarrest situations and during resuscitation it is essential to rule out reversible causes, of which hyperkalemia is one of the most common. Hyperkalemia, a relatively common condition in patients, may lead to fatal cardiac arrythmias. Multiple ECG alterations, however, should draw attention to potentially life threatening conditions. These results imply that treatment of hyperkalemia in the prehospital setting should be initiated with caution. ConclusionsĪ minority of patients with normal potassium levels may also exhibit ECG alterations considered to be suggestive of hyperkalemia, while more than half of the patients with hyperkalemia do not have ECG alterations suggesting hyperkalemia. Upon examining ECG alterations not typically associated with hyperkalemia, we found that prolonged QTc was the only ECG alteration which was significantly more prevalent in both patients with moderate (17.5%) and severe hyperkalemia (21.1%) compared to patients with normokalemia (5.3%). There was no significant difference between the frequency of ECG alterations suggestive of hyperkalemia in normokalemic and moderately hyperkalemic patients. Wide QRS (31.6%), peaked T-waves (18.4%), Ist degree AV-block (18.4%) and bradycardia (18.4%) were the most common and significantly more frequent ECG alterations suggestive of hyperkalemia in severely hyperkalemic patients compared with normokalemic patients (8.2, 4.7, 7.1 and 6.5%, respectively). ResultsĢ4% of normokalemic patients and 46% of patients with elevated potassium levels had some kind of ECG alteration suggestive of hyperkalemia. ![]() χ 2 test and Fischer exact tests were applied. Statistical analysis was performed using SPSS22 software. ECG obtained upon admission were analyzed by two emergency physicians, independently, blinded to the objectives of the study. Methodsġ70 patients with normal potassium (K +) levels and 135 patients with moderate (serum K + = 6.0–7.0 mmol/l) or severe (K + > 7.0 mmol/l) hyperkalemia, admitted to the Department of Emergency Medicine at the Somogy County Kaposi Mór General Hospital, were selected for this retrospective, cross-sectional study. ![]() The aim of our study was to compare the prevalence of ECG alterations suggestive of hyperkalemia in normokalemic and hyperkalemic patients. ![]() Typical electrocardiogram (ECG) alterations may indicate hyperkalemia. Hyperkalemia is one of the most common, reversible causes of periarrest situations. In periarrest situations and during resuscitation it is essential to rule out reversible causes. ![]()
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