This EKG comes courtesy of Dr. Ross Hardy.
A 62 year old male with a history of diabetes presents for generalized weakness for a few days. He also reports nausea and vomiting. He has no fever. No chest pain. Mild shortness of breath.
Vital signs: Pulse – 50, Respirations – 22, BP 160/90, O2 sat 99%, blood glucose 110.
His EKG is below.
1. What does the EKG demonstrate?
2. How would you manage this patient?
The EKG demonstrates bradycardia with peaked T waves, loss of P waves, and a widening of the QRS complex. This is consistent with hyperkalemia.
The patient should be treated with calcium for myocardial protection. A potassium level should be checked and other medications to lower the potassium should be administered.
The EKG shows sinus bradycardia with a PAC. There are peaked T waves, loss of P waves, and a widening of the QRS complex.
Labs revealed BUN 90, Creatinine 9, potassium 8.1.
The patient was treated with calcium which improved the EKG. He also was given glucose/insulin and albuterol and was sent for emergent dialysis.
Hyperkalemia causes a series of changes to the EKG. An early sign is peaked T waves. This is followed by flattening of P waves, widening of the QRS complex and ultimately a sine wave. Whenever you see a wide QRS complex with a bizarre rhythm or what looks like “slow V-tach”, think about hyperkalemia.