Title: ST-Segment Elevation Resulting From Hyperkalemia
Abstract: HomeCirculationVol. 111, No. 19ST-Segment Elevation Resulting From Hyperkalemia Free AccessReview ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessReview ArticlePDF/EPUBST-Segment Elevation Resulting From Hyperkalemia Daniel B. Sims, MD and Laurence S. Sperling, MD Daniel B. SimsDaniel B. Sims From the Department of Medicine, Emory University School of Medicine, Atlanta, Ga. and Laurence S. SperlingLaurence S. Sperling From the Department of Medicine, Emory University School of Medicine, Atlanta, Ga. Originally published17 May 2005https://doi.org/10.1161/01.CIR.0000165127.41028.D1Circulation. 2005;111:e295–e296A 20-year-old man with a history of type 1 diabetes mellitus presented to the emergency department with nausea, vomiting, and abdominal pain of 8 hours' duration. Diabetic ketoacidosis was diagnosed based on a glucose of 68.8 mmol/L (1240 mg/dL), bicarbonate of 5 mmol/L, pH of 6.92, and a positive urine dipstick for ketones. Serum potassium measured 9.4 mmol/L. An ECG (Figure 1) revealed ST-segment elevation (asterisks); a wide QRS complex tachycardia; absent P waves; and tall, peaked, and tented T waves (arrows). One hour after the patient received intravenous fluid, calcium gluconate, bicarbonate, and insulin, the electrocardiographic abnormalities had resolved (Figure 2), leaving only sinus tachycardia secondary to volume depletion and minimal peaking of the T waves (arrows). Serum potassium now measured 5.7 mmol/L. Creatine kinase, creatine kinase-MB, and troponin I values were normal. At the time of discharge, the patient was in good condition, with a normal ECG. Download figureDownload PowerPointFigure 1. ECG obtained on presentation to the emergency department demonstrating a wide complex tachycardia, absent P waves, peaked T waves (arrows), and ST-segment elevation (asterisks) in leads V1, V2, and aVR. Serum potassium measured 9.4 mmol/L.Download figureDownload PowerPointFigure 2. ECG 1 h after initiation of treatment. Minimally peaked T waves (arrows) and sinus tachycardia remain. Serum potassium measured 5.7 mmol/L.Hyperkalemia can cause several characteristic ECG abnormalities that are often progressive. Initially, the T wave becomes tall, symmetrically peaked, and tented. Widening of the QRS complex with an intraventricular conduction delay then occurs. Additional elevation of serum potassium leads to a decrease in the amplitude of the P wave and its eventual disappearance from the ECG. Rarely, ST-segment elevation mimicking myocardial infarction, described as a "pseudoinfarction" pattern, is present. Further progression of hyperkalemia leads to a sine wave appearance of the ECG and eventual asystole.FootnotesCorrespondence to Daniel B. Sims, MD, Glenn Building, Emory University School of Medicine, 69 Jesse Hill Jr Dr, SE, Atlanta, GA 30303. E-mail [email protected] Previous Back to top Next FiguresReferencesRelatedDetailsCited By Jolobe O (2021) Differential diagnosis of the association of gastrointestinal symptoms and ST segment elevation, in the absence of chest pain, The American Journal of Emergency Medicine, 10.1016/j.ajem.2021.05.067, 49, (137-141), Online publication date: 1-Nov-2021. Lee D, Ko S, Park K and Lee K (2021) Electrocardiographic Abnormalities following Syncope during Warm-up in a Professional Football Player: A Case Report, The Korean Journal of Sports Medicine, 10.5763/kjsm.2021.39.3.131, 39:3, (131-134), Online publication date: 1-Sep-2021. 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Littmann L, Monroe M, Taylor L and Brearley W (2007) The hyperkalemic Brugada sign, Journal of Electrocardiology, 10.1016/j.jelectrocard.2006.10.057, 40:1, (53-59), Online publication date: 1-Jan-2007. May 17, 2005Vol 111, Issue 19 Advertisement Article InformationMetrics https://doi.org/10.1161/01.CIR.0000165127.41028.D1PMID: 15897351 Originally publishedMay 17, 2005 PDF download Advertisement SubjectsDiabetes, Type 1Electrocardiology (ECG)