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?

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College Answer


Potassium level


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


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.


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.