Electrocardiographic Abnormalities in Patients with Hyperkalemia: A Retrospective Study in an Emergency Department in
Jaime A Quintero1,2,3, Camilo A Medina1,4,5, Federico Penagos3,4
1Departamento de Medicina de Emergencias y Cuidado Crítico, Fundación Valle del Lili, Cali, Colombia.
Insights
Hyperkalemia, or high potassium levels, often causes abnormal ECGs, but not always. This study found peaked T waves were the most common ECG abnormality in patients with hyperkalemia.
Area of Science:
- Cardiology
- Nephrology
- Emergency Medicine
Background:
- Hyperkalemia is a common electrolyte disorder associated with electrocardiographic (ECG) abnormalities.
- However, ECG findings may be absent or minimal in some patients with elevated serum potassium levels, particularly those with chronic kidney disease.
- Understanding the relationship between hyperkalemia severity and ECG findings is crucial for patient management.
Purpose of the Study:
- To identify electrocardiographic abnormalities associated with hyperkalemia severity.
- To evaluate the clinical outcomes of patients with hyperkalemia in an emergency department.
- To investigate the prevalence of ECG abnormalities in relation to potassium levels.
Main Methods:
- Retrospective cross-sectional descriptive study.
- Analysis of electrocardiographic findings, clinical characteristics, treatment, and outcomes in 494 patients.
- Evaluation of the association between hyperkalemia severity and ECG abnormalities.
Main Results:
- The median potassium level was 6.6 mEq/L, with 61.5% of patients exhibiting abnormal ECG findings.
- Peaked T waves (36.2%) were the most frequent abnormality, followed by wide QRS complexes (16.8%).
- Adverse outcomes were low (1.4%), while mortality was 11.9%.
Conclusions:
- Elevated serum potassium levels correlate with ECG abnormalities, though these may be minimal or absent in some cases.
- The peaked T wave is the most common ECG manifestation across varying degrees of hyperkalemia.
- Further research is needed to understand ECG variability in hyperkalemia, especially in patients with renal disease.
Introduction:
Hyperkalemia is a prevalent electrolyte disorder related to elevated serum potassium levels, resulting in diverse abnormal electrocardiographic findings and associated clinical signs and symptoms, often necessitating specific treatment. However, in some patients, these abnormal findings may not be present on the electrocardiogram even in elevated serum potassium levels. This study aims to identify electrocardiographic abnormalities related to the severity of hyperkalemia and the clinical outcomes in an emergency department in southwestern Colombia.
Methodology:
This is a retrospective cross-sectional descriptive study. We described the electrocardiographic findings, clinical characteristics, treatment, and outcomes related to the degrees of hyperkalemia. The potential association between the severity of hyperkalemia and electrocardiographic findings was evaluated.
Results:
A total of 494 patients were included. The median of the potassium level was 6.6 mEq/L. Abnormal electrocardiographic findings were reported in 61.5% of the cases. Mild and severe hyperkalemia groups reported abnormalities in 59.9% and 61.2%, respectively. The most common electrocardiography abnormalities were the peaked T wave 36.2%, followed by wide QRS 83 (16.8%). Only 1.4% of patients had adverse outcomes. The abnormal findings were registered in 61.5%. Mortality was 11.9%. The peaked T wave was the most common finding across different levels of hyperkalemia severity.
Conclusion:
High serum potassium levels are related with abnormal ECG. However, patients with different degrees of hyperkalemia could not describe abnormal ECG findings. In a high proportion of patients with renal chronic disease and hyperkalemia, the abnormalities in the ECG could be minimal or absent.
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