Podcast 799: EKG Abnormalities in Renal Failure

<p><strong>Contributor: Peter Bakes, MD</strong></p> <p><strong>Educational Pearls:</strong></p> <ul> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Patients in renal failure may have elevated serum potassium levels which can result in EKG changes.  </span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">EKG changes in the setting of hyperkalemia generally depend on the serum level. Mild elevation may cause peaked T waves. At higher serum levels there will be loss of P waves plus wide complex tachycardia. There can be progression to fatal arrhythmias.  </span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Treatment of acute hyperkalemia involves multiple mechanisms. Calcium gluconate stabilizes the cardiac membrane (of note, its duration of action is 1 hour). Insulin with Glucose and Bicarbonate both act to shift extracellular potassium into cells. Enhanced elimination of potassium is accomplished via Kayexalate or Lokelma. Definitive treatment for hyperkalemia is hemodialysis.  </span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">The differential for wide complex non-tachycardic rhythm on EKG includes: left ventricular hypertrophy, left bundle branch block, pacemaker, electrolyte abnormalities including hyperkalemia.  </span></li> </ul> <p><strong>References</strong></p> <p><span style="font-weight: 400;">Palmer BF, Clegg DJ. Diagnosis and treatment of hyperkalemia.</span> <em><span style= "font-weight: 400;">Cleve Clin J Med</span></em><span style= "font-weight: 400;">. 2017;84(12):934-942. doi:10.3949/ccjm.84a.17056</span></p> <p><span style="font-weight: 400;">Watanabe R. Hyperkalemia in chronic kidney disease.</span> <em><span style= "font-weight: 400;">Rev Assoc Med Bras (1992)</span></em><span style="font-weight: 400;">. 2020;66Suppl 1(Suppl 1):s31-s36. Published 2020 Jan 13. doi:10.1590/1806-9282.66.S1.31</span></p> <p> </p> <p><em><span style="font-weight: 400;">Sum