Podcast 799: EKG Abnormalities in Renal Failure

Podcast 799: EKG Abnormalities in Renal Failure

Contributor: Peter Bakes, MD

Educational Pearls:

  • Patients in renal failure may have elevated serum potassium levels which can result in EKG changes.
  • 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.
  • 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.
  • The differential for wide complex non-tachycardic rhythm on EKG includes: left ventricular hypertrophy, left bundle branch block, pacemaker, electrolyte abnormalities including hyperkalemia.

References

Palmer BF, Clegg DJ. Diagnosis and treatment of hyperkalemia. Cleve Clin J Med. 2017;84(12):934-942. doi:10.3949/ccjm.84a.17056

Watanabe R. Hyperkalemia in chronic kidney disease. Rev Assoc Med Bras (1992). 2020;66Suppl 1(Suppl 1):s31-s36. Published 2020 Jan 13. doi:10.1590/1806-9282.66.S1.31

Summarized by Kirsten Hughes, MS4 | Edited by John Spartz, MD & Erik Verzemnieks, MD

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Podcast 875: A Pediatric Case of Myopericarditis

Podcast 875: A Pediatric Case of Myopericarditis

Contributor: Meghan Hurley MD Educational Pearls: Pericarditis is inflammation of the pericardial sac, which can arise from infectious or non-infectious etiologies Myocarditis is inflammation of t...

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Episode 874: Bradyarrhythmias

Episode 874: Bradyarrhythmias

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Podcast 873: Intravesical Tranexamic Acid for Gross Hematuria

Podcast 873: Intravesical Tranexamic Acid for Gross Hematuria

Contributor: Aaron Lessen MD Educational Pearls: Tranexamic acid (TXA) is a common medication to achieve hemostasis in a variety of conditions Patients visiting the ED for gross hematuria (between...

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Podcast 872: Preseptal and Orbital Cellulitis

Podcast 872: Preseptal and Orbital Cellulitis

Contributor: Meghan Hurley MD Educational Pearls: What is Cellulitis? A common and potentially serious bacterial skin infection. Caused by various types of bacteria, with Streptococcus and Staphyl...

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Mental Health Monthly #17: Mania

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Contributors: Andrew White MD - Outpatient Psychiatrist; Fellowship Trained in Addiction Psychiatry; Denver Health Travis Barlock MD - Emergency Medicine Physician; Swedish Medical Center Summary In t...

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Podcast 871: Increased Intracranial Pressure and the Cushing Reflex

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On The Streets #15: Hydrofluoric Acid Case Review

On The Streets #15: Hydrofluoric Acid Case Review

Contributors: Kalen Abbott, MD - EM Physician and Medical Director for AirLife Denver Brendan Reiss - Flight Nurse AirLife Denver Matt Spoon - Flight Paramedic AirLife Denver Jordan Ourada - E...

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Episode 870: Advanced Trauma Life Support (ATLS)

Episode 870: Advanced Trauma Life Support (ATLS)

Contributor: Meghan Hurley MD Educational Pearls: What is ATLS? Advanced Trauma Life Support (ATLS) is a systematic and comprehensive approach to the evaluation and management of trauma patients I...

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