Open AccessAtypical electrocardiographic findings in severe hyperkalemia with slow clinical course
Author(s) -
Sasaki Osamu,
Uriuda Yozo,
Shinkai Masaharu,
Sasaki Hideki
Publication year - 2021
Publication title -
journal of general and family medicine
Language(s) - English
Resource type - Journals
ISSN - 2189-7948
DOI - 10.1002/jgf2.381
Subject(s) - medicine , hyperkalemia , emergency department , vomiting , bradycardia , t wave , electrocardiography , anesthesia , asystole , weakness , lumbar , pediatrics , surgery , blood pressure , heart rate , psychiatry
A 77‐year‐old woman walked into the emergency department with an episode of syncope and vomiting. She had visited at an orthopedic clinic with weakness of the lower extremities 6 weeks before, but cervical and lumbar MRI findings were unremarkable. Thereafter, she developed fingertip numbness and appetite loss at 7 and 3 days, respectively, before admission. She had been prescribed with RAS inhibitors for years. Electrocardiography while in the emergency department revealed bradycardia with normal QRS and a tented T wave. Laboratory findings revealed serum potassium 9.2 mEq/L. We discontinued RAS inhibitors and β‐blockers and added glucose‐insulin therapy. Thereafter, her general condition gradually recovered, and her symptoms completely disappeared. Elderly patients with chronic kidney disease treated with RAS inhibitors might develop slowly progressive symptoms of hyperkalemia. Electrocardiographic findings could be atypical and inconsistent with serum potassium values.