Case #2 Answers:

Answer 1

• Is the patient on telemetry? If not, can we please get a 12-lead EKG. Anticipate short and/or long-term management strategies.
• On the EKG you are looking for peaked t-waves (figure 1) prolongation of the QRS comlpex (0.14 to 0.16 seconds) (figure 2).

Answer 2

• Previous potassium levels, medicines (ACEI, NSAIDs, KCL supplements), medical illnesses (AKI, sepsis, hypotension, rhabdo, tumor lysis, hemolysis e.g. sickle cell disease/crisis), EKG changes
• Is the specimen hemolyzed?
• The most serious manifestations of hyperkalemia are muscle weakness or paralysis, cardiac conduction abnormalities, and cardiac arrhythmias, including sinus bradycardia, sinus arrest, slow idioventricular rhythms, ventricular tachycardia, ventricular fibrillation, and asystole.
• Recognize that acute changes in potassium are more serious than absolute levels

 

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Figure 1 A tall peaked and symmetrical T wave is the first change seen on the electrocardiogram (ECG) in a patient with hyperkalemia



Figure 3 Lateral precordial leads showing peaked, narrow (tented) T waves and prolongation of the QRS complex (0.14 to 0.16 seconds) associated with moderate to severe hyperkalemia.