Whereas the treatment of significant hyperkalaemia is pre-emptive in the patient without electrocardiographic change, in the presence of electrocardiographic change significant hyperkalaemia represents a true medical emergency and requires rapid implementation of measures to reduce serum potassium concentration. Continuous ECG monitoring should occur until serum potassium values have been brought into a safe range and cardiotoxicity has resolved. ECG Changes in Hyperkalaemia Figure 1 ECG findings in the precordial leads in hyperkalaemia The ECG is vital in the assessment of hyperkalaemia, as ECG findings will progress with increasing serum levels. Significant hyperkalaemia represents a medical emergency, and an ECG should be obtained to establish whether cardiotoxicity is present. The earliest manifestation of hyperkalaemia is an increase in T wave amplitude. ECG changes generally do not manifest until there is a moderate degree of hyperkalaemia ( 6.0 mmol/L). Copyright ©2009 by the BMJ Publishing Group. Hyperkalaemia is defined as a serum potassium level of > 5.2 mmol/L. 1), potentially life-threatening arrhythmias can occur without warning in hyperkalaemia. Whilst the ECG findings generally can be correlated to the serum potassium concentration (Fig. : ECG changes in patients with hyperkalaemia BMJ 2009 339:b4114. The ECG is vital in the assessment of hyperkalaemia, as ECG findings will progress with increasing serum levels. Mattu A, Brady WJ, Robinson DA. Electrocardiographic manifestations of hyperkalemia. Clinical manifestations of hyperkalaemia are uncommon with values <6.0 mmol/L (<6.0 mEq/L).Ĭommon acute manifestations of significant hyperkalaemia include muscle weakness and ECG changes, with the latter having the potential to progress to a life-threatening arrhythmia. There is a limited correlation between an elevated serum potassium value and an excess in total body potassium stores. Hyperkalaemia is most commonly due either to high intake of potassium in the setting of decreased renal excretion or to extracellular redistribution of potassium from intracellular locations. Small changes in serum potassium values can have significant muscular and cardiac effects when significant hyperkalaemia is present. Moderate hyperkalaemia is defined as serum potassium values in the 5.0 to 6.0 mmol/L (5.0 to 6.0 mEq/L) range. Hyperkalemia is an electrolyte abnormality seen in the emergency department as well as in hospitalized patients and it can be associated with adverse clinical outcomes and death if not treated appropriately. Significant hyperkalaemia is defined as a serum potassium value >6.0 mmol/L (>6.0 mEq/L).
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