ECG Guru - Instructor Resources - Acidosis https://www.ecgguru.com/ecg/acidosis en Hyperkalemia in a DKA Patient https://www.ecgguru.com/ecg/hyperkalemia-dka-patient <div class="field field-name-field-ecg field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/ecg/hyperkalemia-dka-patient"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/48-M%20DKA%20Hyperkalemia%205%2059%20am%20edited.jpg" width="1800" height="684" alt="" /></a></div><div class="field-item odd"><a href="/ecg/hyperkalemia-dka-patient"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/48-M%20DKA%20Hyperkalemia%206%2012%20edited.jpg" width="1800" height="684" alt="" /></a></div></div></div><div class="field field-name-field-ecg-interpretation field-type-text-long field-label-hidden"><div class="field-items"><div class="field-item even"><p>For your collection, we present another interesting set of ECGs from Paramedic Erik Testerman. &nbsp;They are from a 48 year old man who presented responsive only to painful stimuli, with deep, rapid (Kussmaul's) respirations. &nbsp;His blood glucose in the field read as "HIGH" - too high for the glucometer to register a number. &nbsp;He was treated with 3 large-bore IVs, 2 liters of NSS IV, O2. &nbsp;At the hospital, his blood glucose again registered as "HIGH" on the glucometer, arterial O2 was 90%, CO2 15 (low), pH 6.8 (acidotic), HCO3 -2 (depleted). &nbsp;His serum potassium was 7.0 ( greater than 5.5 is high ). &nbsp;We do not have the rest of his chemistry panel.</p><p>The first ECG, at 5:59 am, shows some signs of early hyperkalemia. &nbsp;One of these signs is&nbsp;<strong>wide QRS,</strong> at .188 sec (normal is less than .12). &nbsp;This ECG even meets the criteria for LBBB, as noted in the machine's interpretation, but the widening is more likely due to the high potassium. &nbsp;There is a right axis deviation. &nbsp;Left axis deviation is more likely in LBBB. LBBB pattern with right axis deviation can be a sign of biventricular enlargement, but, again, this may be an intraventricular conduction delay that is NOT LBBB. &nbsp;Another sign of hyperkalemia is that <strong>P waves are not evident.</strong>&nbsp; They can either be flattened until they disappear, or the PR interval can become so long the P wave is lost in the preceding T wave. &nbsp;The <strong>T waves are unusually tall and peaked</strong> in the chest leads - disproportionate to the wide QRS complexes. &nbsp;There are ST depressions in the inferior leads.</p><p>For a good, systematic approach to the ECG changes associated with hyperkalemia, we recommend <a title="LITFL Hyperkalemia" href="http://lifeinthefastlane.com/ecg-library/basics/hyperkalaemia/">Life In The Fast Lane</a>, by Ed Burns.</p><p>ECG number 2 was taken 13 minutes later, still in the pre-hospital phase. &nbsp;The QRS is now .13 seconds, and the tall, narrow, peaked T waves are very evident in Leads V1 through V3. &nbsp;There is &nbsp;T wave inversion and ST depression in the inferior leads. &nbsp;These are all possible signs of hyperkalemia, but also of other conditions. &nbsp;Unfortunately, hyperkalemia is a "mimic" of many conditions on the ECG. &nbsp;For a very interesting discussion of this topic, please go to <a title="Amal Mattu Hyperkalemia" href="http://ekgumem.tumblr.com/post/64011053244/electrocardiographic-syphilis-episode">Dr. Amal Mattu's ECG Discussion of the Week, October 14, 2013. &nbsp;&nbsp;</a></p><p>Diabetic ketoacidosis and hyperglycemia are frequently associated with hyperkalemia, and it is a potentially deadly consequence of DKA. &nbsp;Unless there are other complicating conditions, the total body potassium is usually not high. &nbsp;The K has been forced out of the cells into the serum. &nbsp;Treatment is aimed at fascilitating K entry into the cells. &nbsp;Once this is accomplished, potassium may need to be replaced. &nbsp;Metabolic acidosis is corrected with Na Bicarb and optimal respiration. &nbsp;Potassium is "pumped" back into the cells by IV calcium followed by insulin and glucose.</p><p>The ECG changes of uncorrected hyperkalemia can progress very rapidly from tall, peaked T waves and slightly widened QRS complexes to very wide QRS complexes with no P waves, to sine waves and loss of pulses. &nbsp;It is very important to learn to recognize the ECG signs because they are available immediately, and lab results take time.</p><p>Also worth mentioning, especially in cases of hyperkalemia with no ECG changes, pseudo hyperkalelmia has several causes - the most common being traumatic venipuncture. &nbsp;Too much fist-squeezing, tight tourniquets, and rapid, forceful drawing back of the blood from the vein can damage red blood cells, causing release of their intracellular K into the serum in the tube.</p></div></div></div><div class="field field-name-field-rate-this-content field-type-fivestar field-label-above"><div class="field-label">Rate this content:&nbsp;</div><div class="field-items"><div class="field-item even"><form class="fivestar-widget" action="/taxonomy/term/494/feed" method="post" id="fivestar-custom-widget" accept-charset="UTF-8"><div><div class="clearfix fivestar-average-text fivestar-average-stars fivestar-form-item fivestar-hearts"><div class="form-item form-type-fivestar form-item-vote"> <div class="form-item form-type-select form-item-vote"> <select id="edit-vote--2" name="vote" class="form-select"><option value="-">Select rating</option><option value="20">Give Hyperkalemia in a DKA Patient 1/5</option><option value="40">Give Hyperkalemia in a DKA Patient 2/5</option><option value="60">Give Hyperkalemia in a DKA Patient 3/5</option><option value="80" selected="selected">Give Hyperkalemia in a DKA Patient 4/5</option><option value="100">Give Hyperkalemia in a DKA Patient 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="average-rating">Average: <span >3.7</span></span> <span class="total-votes">(<span >3</span> votes)</span></div></div> </div> </div> </div><input class="fivestar-submit form-submit" type="submit" id="edit-fivestar-submit" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-VH-DarE7vRz4N-p5Ly46-3byYFRL2KKiSGvdiS75Ooo" /> <input type="hidden" name="form_id" value="fivestar_custom_widget" /> </div></form></div></div></div><div class="field field-name-field-taxonomy field-type-taxonomy-term-reference field-label-above"><div class="field-label">Related Terms:&nbsp;</div><div class="field-items"><div class="field-item even"><a href="/ecg/hyperkalemia" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Hyperkalemia</a></div><div class="field-item odd"><a href="/ecg/dka" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">DKA</a></div><div class="field-item even"><a href="/ecg/acidosis" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Acidosis</a></div><div class="field-item odd"><a href="/ecg/wide-qrs" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Wide QRS</a></div></div></div><ul class="links inline"><li class="addtoany first last"><span><span class="a2a_kit a2a_target addtoany_list" id="da2a_1"> <a class="a2a_dd addtoany_share_save" href="https://www.addtoany.com/share#url=https%3A%2F%2Fwww.ecgguru.com%2Fecg%2Fhyperkalemia-dka-patient&amp;title=Hyperkalemia%20in%20a%20DKA%20Patient"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> <script type="text/javascript"> <!--//--><![CDATA[//><!-- if(window.da2a)da2a.script_load(); //--><!]]> </script></span></li> </ul> Sun, 04 May 2014 20:14:34 +0000 Dawn 572 at https://www.ecgguru.com https://www.ecgguru.com/ecg/hyperkalemia-dka-patient#comments