An unusual manifestation of hyperkalemia
Ahmed Belkouch, Lahcen Belyamani
The Pan African Medical Journal. 2014;19:251. doi:10.11604/pamj.2014.19.251.5007

Create an account  |  Sign in
EPI Helina 2017
"Better health through knowledge sharing and information dissemination "

Images in medicine

An unusual manifestation of hyperkalemia

Cite this: The Pan African Medical Journal. 2014;19:251. doi:10.11604/pamj.2014.19.251.5007

Received: 12/07/2014 - Accepted: 31/10/2014 - Published: 07/11/2014

Key words: Hyperkalemia, atrioventricular bloc, emergency

© Ahmed Belkouch et al. The Pan African Medical Journal - ISSN 1937-8688. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Available online at: http://www.panafrican-med-journal.com/content/article/19/251/full

Corresponding author: Ahmed Belkouch, Emergency Department, Military Hospital of Instruction Mohamed V, Rabat, Morocco (belkouch1@gmail.com)


An unusual manifestation of hyperkalemia

 

Ahmed Belkouch1,&, Lahcen Belyamani1

 

1Emergency Department, Military Hospital of Instruction Mohamed V, Rabat, Morocco

 

 

&Corresponding author
Ahmed Belkouch, Emergency Department, Military Hospital of Instruction Mohamed V, Rabat, Morocco

 

 

Image in medicine

An 82 years old patient was admitted to the emergency department complaining since 15 days of fatigue, dizziness and lipothymia. He had a history of hypertension and diabetes; and had undergone a coronary bypass in 2005. His physical examination showed a blood pressure at 160/50mmHg, a heart rate at 26cycles/min, and he was afebrile. On admission the ECG showed a third degree atrioventricular bloc with a regular rhythm at 26 cycles/min, P wave was absent, QRS complex was not wide (<0.10ms) and the T wave was not “tente like”, tall, peaked and symmetric, it was negative in the inferior territory and the ST segment was underlined in the laterobasal derivations. The laboratory findings included a serum potassium level of 6.9mEq/l (normal 3.6-5.5), sodium 132mEq/l (normal 135-140), creatinine 30mg/l (6-14) and urea nitrogen 0.82g/l (0.17-0.43), MDRD clearance was at 20ml/min (normal>80). The arterial blood gas analysis revealed a pH of 7.32, pO2=115mmHg, and pCO2=34mmHg. The patient was treated immediately with furosemide, bicarbonate serum, calcium gluconate, glucose solution, and insulin, after three hours, the ECG showed normal sinus rhythm with visible P waves, a heart rate at 60cycles/min and a shortening of the QT interval in comparison with the first ECG. Blood potassium at this moment was at 5.60mEq/l. Hyperkalemia is known to cause a depression of the conduction velocity and excitability of the pacemaker cells and conduction tissues, resulting generaly in an advanced atrioventricular bloc with wide QRS complex. In this case the QRS remained normal.

Figure 1: (A) ECG of admission showing the third degree atriventricular bloc, with absence of P wave and normal QRS, (B)ECG after correction of the hyperkalaemia

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


The Pan African Medical Journal articles are archived on Pubmed Central. Access PAMJ archives on PMC here

Volume 26 (Jan - Apr 2017)

Article tools

This article authors

On Pubmed
On Google Scholar

Navigate this article

Rate this article

Altmetric

PAMJ is a member of the Committee on Publication Ethics

PAMJ is published in collaboration with the African Field Epidemiology Network (AFENET)
Currently tracked by: DOAJ, AIM, Google Scholar, AJOL, EBSCO, Scopus, Embase, IC, HINARI, Global Health, PubMed Central, PubMed/Medline, Ulrichsweb, More to come . Member of COPE.

ISSN: 1937-8688. © 2017 - Pan African Medical Journal. All rights reserved