Reversible junctional bigeminy in severe hyperkalemia: electrocardiographic and biochemical correlation: A case...

Severe hyperkalemia is classically associated with peaked T waves, PR prolongation, and QRS widening. However, sustained bigeminal rhythms resulting from junctional escape are exceptionally rare. Detailed correlations between electrocardiographic (ECG) changes and serum potassium levels remain scarce in the literature.

A 54-year-old man with end-stage renal disease on maintenance hemodialysis presented with hypotension and bradycardia.

ECG revealed a striking bigeminal rhythm characterized by alternating supraventricular and junctional escape complexes, an uncommon arrhythmic manifestation of hyperkalemia. Laboratory testing showed a serum potassium level of 7.5 mmol/L.

The patient underwent emergent hemodialysis for rapid potassium removal and received standard supportive management for hyperkalemia.

Following hemodialysis, serum potassium normalized to 3.7 mmol/L, and the bigeminal rhythm resolved completely, with restoration of normal sinus rhythm. Serial ECGs demonstrated dynamic and reversible conduction changes in parallel with biochemical correction.

This case highlights a rare but reversible presentation of junctional bigeminy secondary to hyperkalemia. Recognition of this distinctive ECG pattern - correlated with paired serum potassium values - can facilitate timely diagnosis and prevent unnecessary interventions.