Question 18.2
The following ECG (labelled ECG 2) is that of a haemodialysis patient presenting with pulmonary oedema.
- What test will you do to confirm the likely underlying diagnosis?
- What is your immediate management for this condition?
College Answer
a)
Potassium level
b)
Counteract cardiotoxic effects of hyperkalaemia
- Calcium chloride
- Sodium bicarbonate
Shift potassium into the cells
- Dextrose and insulin
- Beta agonists
Remove potassium (and water)
- Urgent haemodialysis
Discussion
This is a pattern-recognition ECG question requiring little discussion.
The abnormality is obvious, and the question hints at the solution by mentioning hemodialysis.
Interestingly, chronically hyperkalemic patients on hemodialysis dont seem to have a classical presentation of ECG changes, making it difficult for their physician to predict a hyperkalemic arrest.
References
Montague, Brian T., Jason R. Ouellette, and Gregory K. Buller. "Retrospective review of the frequency of ECG changes in hyperkalemia." Clinical Journal of the American Society of Nephrology 3.2 (2008): 324-330.
Weisberg, Lawrence S. "Management of severe hyperkalemia." Critical care medicine 36.12 (2008): 3246-3251.