Question 23.1

A 45 year old woman is admitted with hyperosmolar hyperglycaemic non-ketotic coma (HONK). A routine ECG is performed. 

  • What does it show?
  • What is your treatment of this problem? 

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College Answer

  • Flattening of P waves & peaked T waves consistent with hyperkalaemia.
  • Treatment of hyperkalaemia:
    • Intravenous calcium based on K levels
    • Bicarbonate
    • Insulin/? Dextrose if she has HONK
    • Resonium / beta 2 agonists
    • Investigate for cause
    • Renal function/electrolytes


The referenced article takes good care of the latter. The former is immediately recogniseable and requires little further discussion.

Again, I extend my thanks to LITFL for making public their awesome and massive ECG library.  


Weisberg, Lawrence S. "Management of severe hyperkalemia." Critical care medicine 36.12 (2008): 3246-3251.