Sinus arrest consequence of moderate hyperkalemia: a case report

Area of Science:

• Nephrology
• Cardiology
• Internal Medicine

Background:

• Hyperkalemia, a common complication in end-stage renal disease (ESRD) patients undergoing hemodialysis, poses a significant risk for life-threatening cardiac arrhythmias.
• Electrocardiogram (ECG) findings for hyperkalemia often lack definitive sensitivity and specificity, complicating diagnosis.
• Serum potassium levels do not always correlate with the severity of ECG abnormalities.

Observation:

• An elderly female ESRD patient on hemodialysis presented with sinus arrest.
• The patient's ECG did not exhibit typical hyperkalemia-associated changes.
• Moderate hyperkalemia was identified as the cause of the sinus arrest.

Findings:

• Sinus arrest occurred in the absence of classic ECG indicators of hyperkalemia.
• Correction of the electrolyte imbalance led to the restoration of normal sinus rhythm.
• This case underscores the diagnostic challenges posed by atypical ECG presentations of hyperkalemia.

Implications:

• Clinicians must maintain a high index of suspicion for hyperkalemia-induced ECG abnormalities, even when typical findings are absent.
• Prompt diagnosis and intervention are crucial for managing hyperkalemia and preventing fatal arrhythmias.
• This case emphasizes the importance of considering electrolyte disturbances in patients with unexplained cardiac rhythm abnormalities, particularly those with ESRD.