ECG alterations suggestive of hyperkalemia in normokalemic versus hyperkalemic patients

C. Varga, Zsolt Kálmán, Alíz Szakáll, Kata Drubits, Márton Koch, Róbert Bánhegyi, Tibor Oláh, Éva Pozsgai, Norbert Fülöp, József Betlehem

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: In periarrest situations and during resuscitation it is essential to rule out reversible causes. Hyperkalemia is one of the most common, reversible causes of periarrest situations. Typical electrocardiogram (ECG) alterations may indicate hyperkalemia. The aim of our study was to compare the prevalence of ECG alterations suggestive of hyperkalemia in normokalemic and hyperkalemic patients. Methods: 170 patients with normal potassium (K+) levels and 135 patients with moderate (serum K+ = 6.0-7.0 mmol/l) or severe (K+ > 7.0 mmol/l) hyperkalemia, admitted to the Department of Emergency Medicine at the Somogy County Kaposi Mór General Hospital, were selected for this retrospective, cross-sectional study. ECG obtained upon admission were analyzed by two emergency physicians, independently, blinded to the objectives of the study. Statistical analysis was performed using SPSS22 software. χ2 test and Fischer exact tests were applied. Results: 24% of normokalemic patients and 46% of patients with elevated potassium levels had some kind of ECG alteration suggestive of hyperkalemia. Wide QRS (31.6%), peaked T-waves (18.4%), Ist degree AV-block (18.4%) and bradycardia (18.4%) were the most common and significantly more frequent ECG alterations suggestive of hyperkalemia in severely hyperkalemic patients compared with normokalemic patients (8.2, 4.7, 7.1 and 6.5%, respectively). There was no significant difference between the frequency of ECG alterations suggestive of hyperkalemia in normokalemic and moderately hyperkalemic patients. Upon examining ECG alterations not typically associated with hyperkalemia, we found that prolonged QTc was the only ECG alteration which was significantly more prevalent in both patients with moderate (17.5%) and severe hyperkalemia (21.1%) compared to patients with normokalemia (5.3%). Conclusions: A minority of patients with normal potassium levels may also exhibit ECG alterations considered to be suggestive of hyperkalemia, while more than half of the patients with hyperkalemia do not have ECG alterations suggesting hyperkalemia. These results imply that treatment of hyperkalemia in the prehospital setting should be initiated with caution. Multiple ECG alterations, however, should draw attention to potentially life threatening conditions.

Original languageEnglish
Article number33
JournalBMC Emergency Medicine
Volume19
Issue number1
DOIs
Publication statusPublished - May 31 2019

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Hyperkalemia
Electrocardiography
Potassium
Emergency Medicine
Atrioventricular Block
Bradycardia
Resuscitation
General Hospitals
Emergencies

Keywords

  • ECG alterations
  • Hyperkalemia
  • Peaked T wave
  • Periarrest situation
  • Prehospital setting
  • Wide QRS

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Varga, C., Kálmán, Z., Szakáll, A., Drubits, K., Koch, M., Bánhegyi, R., ... Betlehem, J. (2019). ECG alterations suggestive of hyperkalemia in normokalemic versus hyperkalemic patients. BMC Emergency Medicine, 19(1), [33]. https://doi.org/10.1186/s12873-019-0247-0

ECG alterations suggestive of hyperkalemia in normokalemic versus hyperkalemic patients. / Varga, C.; Kálmán, Zsolt; Szakáll, Alíz; Drubits, Kata; Koch, Márton; Bánhegyi, Róbert; Oláh, Tibor; Pozsgai, Éva; Fülöp, Norbert; Betlehem, József.

In: BMC Emergency Medicine, Vol. 19, No. 1, 33, 31.05.2019.

Research output: Contribution to journalArticle

Varga, C, Kálmán, Z, Szakáll, A, Drubits, K, Koch, M, Bánhegyi, R, Oláh, T, Pozsgai, É, Fülöp, N & Betlehem, J 2019, 'ECG alterations suggestive of hyperkalemia in normokalemic versus hyperkalemic patients', BMC Emergency Medicine, vol. 19, no. 1, 33. https://doi.org/10.1186/s12873-019-0247-0
Varga, C. ; Kálmán, Zsolt ; Szakáll, Alíz ; Drubits, Kata ; Koch, Márton ; Bánhegyi, Róbert ; Oláh, Tibor ; Pozsgai, Éva ; Fülöp, Norbert ; Betlehem, József. / ECG alterations suggestive of hyperkalemia in normokalemic versus hyperkalemic patients. In: BMC Emergency Medicine. 2019 ; Vol. 19, No. 1.
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AU - Kálmán, Zsolt

AU - Szakáll, Alíz

AU - Drubits, Kata

AU - Koch, Márton

AU - Bánhegyi, Róbert

AU - Oláh, Tibor

AU - Pozsgai, Éva

AU - Fülöp, Norbert

AU - Betlehem, József

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N2 - Background: In periarrest situations and during resuscitation it is essential to rule out reversible causes. Hyperkalemia is one of the most common, reversible causes of periarrest situations. Typical electrocardiogram (ECG) alterations may indicate hyperkalemia. The aim of our study was to compare the prevalence of ECG alterations suggestive of hyperkalemia in normokalemic and hyperkalemic patients. Methods: 170 patients with normal potassium (K+) levels and 135 patients with moderate (serum K+ = 6.0-7.0 mmol/l) or severe (K+ > 7.0 mmol/l) hyperkalemia, admitted to the Department of Emergency Medicine at the Somogy County Kaposi Mór General Hospital, were selected for this retrospective, cross-sectional study. ECG obtained upon admission were analyzed by two emergency physicians, independently, blinded to the objectives of the study. Statistical analysis was performed using SPSS22 software. χ2 test and Fischer exact tests were applied. Results: 24% of normokalemic patients and 46% of patients with elevated potassium levels had some kind of ECG alteration suggestive of hyperkalemia. Wide QRS (31.6%), peaked T-waves (18.4%), Ist degree AV-block (18.4%) and bradycardia (18.4%) were the most common and significantly more frequent ECG alterations suggestive of hyperkalemia in severely hyperkalemic patients compared with normokalemic patients (8.2, 4.7, 7.1 and 6.5%, respectively). There was no significant difference between the frequency of ECG alterations suggestive of hyperkalemia in normokalemic and moderately hyperkalemic patients. Upon examining ECG alterations not typically associated with hyperkalemia, we found that prolonged QTc was the only ECG alteration which was significantly more prevalent in both patients with moderate (17.5%) and severe hyperkalemia (21.1%) compared to patients with normokalemia (5.3%). Conclusions: A minority of patients with normal potassium levels may also exhibit ECG alterations considered to be suggestive of hyperkalemia, while more than half of the patients with hyperkalemia do not have ECG alterations suggesting hyperkalemia. These results imply that treatment of hyperkalemia in the prehospital setting should be initiated with caution. Multiple ECG alterations, however, should draw attention to potentially life threatening conditions.

AB - Background: In periarrest situations and during resuscitation it is essential to rule out reversible causes. Hyperkalemia is one of the most common, reversible causes of periarrest situations. Typical electrocardiogram (ECG) alterations may indicate hyperkalemia. The aim of our study was to compare the prevalence of ECG alterations suggestive of hyperkalemia in normokalemic and hyperkalemic patients. Methods: 170 patients with normal potassium (K+) levels and 135 patients with moderate (serum K+ = 6.0-7.0 mmol/l) or severe (K+ > 7.0 mmol/l) hyperkalemia, admitted to the Department of Emergency Medicine at the Somogy County Kaposi Mór General Hospital, were selected for this retrospective, cross-sectional study. ECG obtained upon admission were analyzed by two emergency physicians, independently, blinded to the objectives of the study. Statistical analysis was performed using SPSS22 software. χ2 test and Fischer exact tests were applied. Results: 24% of normokalemic patients and 46% of patients with elevated potassium levels had some kind of ECG alteration suggestive of hyperkalemia. Wide QRS (31.6%), peaked T-waves (18.4%), Ist degree AV-block (18.4%) and bradycardia (18.4%) were the most common and significantly more frequent ECG alterations suggestive of hyperkalemia in severely hyperkalemic patients compared with normokalemic patients (8.2, 4.7, 7.1 and 6.5%, respectively). There was no significant difference between the frequency of ECG alterations suggestive of hyperkalemia in normokalemic and moderately hyperkalemic patients. Upon examining ECG alterations not typically associated with hyperkalemia, we found that prolonged QTc was the only ECG alteration which was significantly more prevalent in both patients with moderate (17.5%) and severe hyperkalemia (21.1%) compared to patients with normokalemia (5.3%). Conclusions: A minority of patients with normal potassium levels may also exhibit ECG alterations considered to be suggestive of hyperkalemia, while more than half of the patients with hyperkalemia do not have ECG alterations suggesting hyperkalemia. These results imply that treatment of hyperkalemia in the prehospital setting should be initiated with caution. Multiple ECG alterations, however, should draw attention to potentially life threatening conditions.

KW - ECG alterations

KW - Hyperkalemia

KW - Peaked T wave

KW - Periarrest situation

KW - Prehospital setting

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