ECG Quest > Diagnoses > Electrolytes > Hyperkalemia

Hyperkalemia

Hyperkalemia (high serum potassium) can produce many different ECG signs. It is classically associated with tall peaked T waves, widening of the QRS and flattening or loss of P waves. Severe hyperkalemia risks forming a sine wave and progression to VF.

See also: Electrolytes

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References

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In the ECGquest archives, this ECG has been tagged with: - Absent P waves Peaked T waves Accelerated idioventricular rhythm Hyperkalemia 12-Lead EMergucate CC-BY-NC-SA
ECG of the Week Interpretation – March 20th 2019

This ECG is from a man in his 60s who presented with fever and delirium. He has a history of renal failure, T2DM and cognitive impairment.

This ECG shows accelerated idioventricular rhythm with peaked T waves due to hyperkalemia.

In the ECGquest archives, this ECG has been tagged with: - Cardiac arrest Bradycardia Irregular Peaked T waves Wide QRS Hyperkalemia 12-Lead Dr Smith's ECG Blog Dr Ken Grauer K. Wang CC BY-NC
A patient with cardiac arrest, ROSC, and right bundle branch block (RBBB).

This ECG is from a patient who presented after a PEA arrest with ROSC after intubation and chest compressions.

This ECG shows irregular, slow, wide complex rhythm with peaked T waves due to hyperkalemia.

In the ECGquest archives, this ECG has been tagged with: - Hypotension Bradycardia Irregular Nonspecific baseline artefact Extra P waves Peaked T waves Wide QRS Second degree AV block Hyperkalemia 12-Lead Dr Pendell Meyers Dr Smith's ECG Blog Dr Ken Grauer CC BY-NC
What will you do for this altered and bradycardic patient?

This ECG is from a woman in her 60s who presented from a nursing home with altered mental status, hypotension, hypoxia and bradycardia.

This ECG shows an irregular rhythm due to second degree AV block with wide QRS and peaked T waves. The cause was hyperkalemia.

In the ECGquest archives, this ECG has been tagged with: - Hypotension Pacemaker spikes Wide QRS Ventricular pacemaker Hyperkalemia 12-Lead Dr Pendell Meyers Dr Smith's ECG Blog Dr Ken Grauer CC BY-NC
What will you do for this altered and bradycardic patient? Repeat ECG after transvenous pacemaker

This ECG is from a woman in her 60s who presented from a nursing home with altered mental status, hypotension, hypoxia and bradycardia. This was the repeat ECG after placement of a transvenous pacemaker.

This ECG shows a very wide ventricular paced rhythm with widespread excessive discordant ST elevation. The cause was hyperkalemia.

In the ECGquest archives, this ECG has been tagged with: - Chronic kidney disease Incorrect Machine Interpretation Flat ST segment Peaked T waves Hyperkalemia 12-Lead Dr Smith's ECG Blog Dr Ken Grauer CC BY-NC
I saw this computer “normal” ECG in a stack of ECGs I was reading

This ECG is from a woman of unknown age who presented with a clotted dialysis shunt.

This ECG shows peaked T waves and flattened ST segments caused by hyperkalemia.

In the ECGquest archives, this ECG has been tagged with: - Chronic kidney disease Flat ST segment Peaked T waves Hyperkalemia 12-Lead Dr Smith's ECG Blog Dr Ken Grauer CC BY-NC
What is the diagnosis?

This ECG is from a patient on dialysis who presented after a fall.

This ECG shows flattened ST segments and peaked T waves due to hyperkalemia.

In the ECGquest archives, this ECG has been tagged with: - Long PR Long QT Wide QRS Hyperkalemia Hypocalcaemia 12-Lead ECG of the Week CC-BY-NC-SA
ECG of the Week – 31st December 2018 – Interpretation

This ECG is from a woman in her 30s who presented with cramping following thyroid surgery.

This ECG shows prolonged QT due to long ST segment, no U waves, but also a prolonged QRS and PR. There was hypocalcemia, mild hyperkalemia and hypermagnesemia.

In the ECGquest archives, this ECG has been tagged with: - Loss of consciousness Long QT Peaked T waves Hyperkalemia Hypocalcaemia 12-Lead Dr Smith's ECG Blog CC BY-NC
Found comatose with prehospital ECG showing “bigeminal PVCs” and “Tachycardia at a rate of 156”

This ECG is from a patient with a history of diabetes who was found with a GCS of 4.

This ECG shows sinus rhythm with peaked T waves that were so narrow they were mistaken for separate QRS complexes. The cause was hyperkalemia due to acute renal failure.

In the ECGquest archives, this ECG has been tagged with: - Peaked T waves Wide QRS Hyperkalemia 12-Lead Dr Pendell Meyers Dr Smith's ECG Blog CC BY-NC
Could you have prevented this young man’s cardiac arrest?

This ECG is from a young man who was found at the bottom of his basement stairs. He complained of right hip or leg pain but seemed confused about what had happened. He had a history of IV heroin abuse. Shortly after he had a wide complex PEA arrest and had a ROSC after 20 min of resuscitation with epinephrine, glucose, calcium and bicarb. This was his triage ECG before he arrested.

In the ECGquest archives, this ECG has been tagged with: - Tachycardia Wandering baseline Sinus tachycardia Hyperkalemia 12-Lead Serial 12-lead Dr Pendell Meyers Dr Smith's ECG Blog CC BY-NC
Could you have prevented this young man’s cardiac arrest? Baseline ECG

This ECG is from a young man who was found at the bottom of his basement stairs. He complained of right hip or leg pain but seemed confused about what had happened. He had a history of IV heroin abuse. Shortly after he had a wide complex PEA arrest and had a ROSC after 20 min of resuscitation with epinephrine, glucose, calcium and bicarb. This was his baseline ECG from a previous presentation.

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