Careful evaluation of body fluid volume and the serum potassium level are mandatory. However, this could cause or worsen overhydration and pulmonary edema in patients with DKA who require chronic hemodialysis. Normally, fluid infusion is essential for initial treatment of DKA ( 1). This patient showed had some weight gain over his dry weight and cardiac enlargement on chest x-ray. In patients with diabetes who are anuric, there is a little reduction in weight and circulatory blood volume when the pathological state of DKA develops. The present episode likely depended on absolute lack of insulin action. This patient had a left frontal cerebral infarction resulting in right hemiplegia and higher cortical dysfunction, so we wondered if he had lost the ability to respond to hyperglycemia and handle his insulin pump properly. In addition, reduced renal potassium excretion contributes to hyperkalemia in renal failure ( 4). Lack of insulin action does not produce hyperglycemia alone but also causes potassium to shift from the intracellular to extracellular space by reducing Na +, K +-ATPase activity ( 4). In general, hyperglycemia is positively correlated with the serum potassium level ( 3), but hyperkalemia to this extreme degree is rare. In this patient, extreme hyperkalemia of 9.0 mEq/L with typical hyperkalemic ECG changes was observed. In patients with anuria on hemodialysis, DKA is generally rare, because urinary loss of water and electrolytes does not occur and regular hemodialysis improves metabolic acidosis ( 2). It was unclear when the neurological symptoms exactly appeared. The neurologic examination revealed right hemiplegia and higher cortical dysfunction (aphasia and acalculia).
There was an ejection murmur at the apex and bilateral pretibial pitting edema.
#PEAKED T WAVES IN HYPERKALEMIA SKIN#
His skin turgor was not reduced and the mouth was moist. His blood pressure was 70/50 mmHg, and his pulse rate was regular at 60 beats/min. His level of consciousness was E3V4M5 (Glasgow Coma Scale). The physical findings upon hospitalization included a height of 170 cm and weight of 59 kg, with a body mass index of 20.4. He was trained and informed the risk of DKA at the induction of CSII, but he did not have stripes for measuring ketones. He had been diagnosed with type 1 diabetes mellitus at the age of 18 years and had been treated with continuous subcutaneous insulin infusion (CSII) pump for the preceding recent one year. Then, his family discovered that the patient had disturbed consciousness in his bedroom and called for an ambulance he was taken to the Jichi Medical University Saitama Medical Center. Dialysis clinic staff called him because he did not go to regular hemodialysis at 10:00 h on the day. 2009 339:b4114.A 41-year-old Japanese man with type 1 diabetes had been on chronic hemodialysis (three times per week) due to diabetic nephropathy since the age of 32 years. Cardiac arrest in special circumstances: Electrolyte abnormalities, poisoning, drowning, accidental hypothermia, hyperthermia, asthma, anaphylaxis, cardiac surgery, trauma, pregnancy, electrocution. European Resuscitation Council Guidelines for Resuscitation 2010 Section 8. Treatment of acute hyperkalaemia in adults ECG finding are neither specific nor sensitive for detecting hyperkalaemia (3).the longer a patient has high potassium concentrations, the greater the risk of sudden deterioration (1)Ĭlick here for an example ECG and further information.risk of arrhythmias increase with potassium values > 6.5 mmol/L and even small elevations in potassium above this concentration can lead to rapid progression from peaked T waves to ventricular fibrillation or asystole.cardiac arrest (pulseless electrical activity, ventricular fibrillation/pulseless ventricular tachycardia, asystole) (2)ĮCG changes with hyperkalaemia do not consistently follow a stepwise, dose-dependent pattern.arrythmias including bradycardia, ventricular tachycardia or fibrillation.S and T wave merging (sine wave pattern).
first degree heart block (prolonged PR interval).Hyperkalaemia causes a rapid reduction in resting membrane potential leading to increased cardiac depolarization, and muscle excitability which in turn causes EG changes (1).ĮCG changes are usually progressive and may include: Last edited 02/2018 and last reviewed 10/2022
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