Figure 331

Clinical manifestations of hyperkalemia.

Cardiac

Renal electrolyte

Abnormal electrocardiogram

Decreased renal NH4+ production

Atrial/ventricular arrhythmias

Natriuresis

Pacemaker dysfunction

Endocrine

Neuromuscular

Increased aldosterone secretion

Paresthesias

Increased insulin secretion

Weakness

Paralysis

FIGURE 3-32

Electrocardiographic (ECG) changes associated with hyperkalemia. A, Normal ECG pattern. B, Peaked, narrow-based T waves are the earliest sign of hyperkalemia. C, The P wave broadens and the QRS complex widens when the plamsa potassium level is above 7 mEq/L. D, With higher elevations in potassium, the P wave becomes difficult to identify. E, Eventually, an undulating sinusoidal pattern is evident. Although the ECG changes are depicted here as correlating to the severity of hyperkalemia, patients with even mild ECG changes may abruptly progress to terminal rhythm disturbances. Thus, hyperkalemia with any ECG changes should be treated as an emergency.

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