ECG in Hyperkalemia

Figure

Limb leads on the 12-lead ECG

A 70-year-old male patient was brought in by the emergency services due to a 2-day history of unstable head posture and muscle weakness. A marked tilt of the head was observed, attributed to known left-sided spastic hemiparesis. ECG monitoring showed bradycardia (53/min). P waves were absent on the 12-lead ECG, and rhythmic, significantly widened QRS complexes with a pseudoinfarct pattern were seem—typical of hyperkalemia (a). Blood gas analysis (BGA) confirmed severe hyperkalemia (K+ 9.0 mmol/l). Without delay, calcium gluconate was administered and emergency dialysis performed. The ECG changes typical of hyperkalemia normalized with 1 h (b), and the patient was symptom-free. The trigger was identified as acute kidney injury caused by exsiccosis and chronic diarrhea combined with the use of spironolactone and potassium effervescent tablets. The presence of a sine wave configuration on ECG in combination with muscle weakness is typical in severe hyperkalemia and should prompt immediate evaluation by BGA. The specific treatment comprises intravenous calcium administration and potassium elimination; as a bridging measure, potassium can be shifted intracellularly by administering insulin/glucose or salbutamol.

Dr. med. Christoph Hüser, Universität zu Köln, Medizinische Fakultät und Uniklinik Köln, Schwerpunkt Klinische Notfall- und Akutmedizin, [e-mail]

Dr. med. Johannes Terporten, Dr. med. Sascha Macherey-Meyer, Universität zu Köln, Medizinische Fakultät und Uniklinik Köln, Klinik III für Innere Medizin

Conflict of interest statement: The authors declare that no conflict of interest exists.

Translated from the original German by Christine Rye.

Cite this as: Hüser C, Terporten J, Macherey-Meyer S: ECG in hyperkalemia. Dtsch Arztebl Int 2025; 122: 466. DOI: 10.3238/arztebl.m2025.0117