Severe Persistent Hyperkalemia with Electrocardiogram Changes in a Patient with Hyperaldosteronism.

Area of Science:

• Nephrology
• Cardiology
• Internal Medicine

Background:

• A 62-year-old female with a history of hyperaldosteronism, type 2 diabetes mellitus, chronic kidney disease, and hypertension presented with severe fatigue and weakness.
• Her medical history also included a cerebrovascular accident with residual left-sided weakness.

Observation:

• Initial presentation revealed wide complex tachycardia with sine waves (HR 100-170 bpm) and laboratory findings of severe hyperkalemia (potassium > 10 mmol/L), metabolic acidosis (pH 7.1, bicarbonate 9 mmol/L), and other electrolyte abnormalities.
• Standard treatments for hyperkalemia, including calcium gluconate, salbutamol, glucose/insulin infusion, and calcium polystyrene, were initiated, leading to transient ECG improvement but persistent hyperkalemia.

Findings:

• Despite aggressive medical management, serum potassium levels remained critically high, necessitating further intervention.
• Two hours of hemodialysis effectively reduced the patient's potassium level to 5.2 mmol/L, resolving the life-threatening hyperkalemia.

Implications:

• This case highlights the critical role of hemodialysis in managing persistent, severe, and life-threatening hyperkalemia, especially in patients with comorbidities and renal impairment.
• Early consideration of hemodialysis may be warranted in refractory cases to prevent potentially fatal cardiac arrhythmias and other complications.