tag:blogger.com,1999:blog-549949223388475481.post7111467344856097510..comments2024-03-28T14:02:08.119-05:00Comments on Dr. Smith's ECG Blog: The blood sample is hemolyzed. Twice. Is there hyperkalemia on the ECG?Unknownnoreply@blogger.comBlogger11125tag:blogger.com,1999:blog-549949223388475481.post-22676718604099288982018-04-25T15:17:29.525-05:002018-04-25T15:17:29.525-05:00Adam,
I looked! None was recorded. Alas.....
Tha...Adam,<br />I looked! None was recorded. Alas.....<br />Thanks!<br />SteveSteve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-51268195652549094032018-04-25T07:10:18.860-05:002018-04-25T07:10:18.860-05:00Hey Dr. Smith, is there maybe an ECG recorded afte...Hey Dr. Smith, is there maybe an ECG recorded after dialysis to compare the PR intervalls? Thanks for the great blog!Adam Blossomnoreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-53863257480396305992018-04-24T07:39:05.658-05:002018-04-24T07:39:05.658-05:00Great comments, Pius!Great comments, Pius!Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-91908098119718303912018-04-24T06:13:35.454-05:002018-04-24T06:13:35.454-05:00Just the opposite!! Hypokalemia does not lengthen...Just the opposite!! Hypokalemia does not lengthen the PR interval. If, significant, it leads to sagging ST segments, U-wave (what often appears to be an impossibly long QT interval, but is really a QU), long QT.<br /><br />See these posts: https://hqmeded-ecg.blogspot.com/search/label/hypokalemiaSteve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-76696397792686294942018-04-22T23:43:33.818-05:002018-04-22T23:43:33.818-05:00Hey Dr. Smith, as a nephrology resident I get this...Hey Dr. Smith, as a nephrology resident I get this scenario quite a lot. malfunctioning shunt i.e. insufficient hemodialysis, tendency towards hyperkalemia, usually not keeping recommended diet and especially "chronic, unspecific symptoms", which cannot be described by most patients. one thing to keep in mind is, that some labs get the message "hemolized" if the k is absurdly high, which lets me draw the blood sample myself in these patients, so I know if there is a mistake in the preanalysis.<br />without knowing the ECG under normal k the dysmorphic QRS-complexes in I, II, aVL and V6 made me think, that something's wrong, even though they are below 100ms as far as I can see.Pius Madjokehttps://www.blogger.com/profile/15979072697162991927noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-32867516516813964742018-04-22T20:02:35.316-05:002018-04-22T20:02:35.316-05:00Steve...
A very good topic and well-presented. Th...Steve...<br /><br />A very good topic and well-presented. The article by Dr. Meyers was also very informative. In my years of practice, I saw many cases of hyperkalemia that were very subtle because we had a huge dialysis population (many of whom were non-compliant) who often tolerated high levels of K+ on a daily basis. Their ECGs could be very misleading. It was always my philosophy to treat if there was ECG evidence of hyperK+ on the basis that by the time changes appeared on the ECG catastrophe was not far behind. Unfortunately I have seen a few articles in the last couple of years that suggest there is no need to treat hyperkalemia until the value of the serum K+ has reached a particular level. Although I have retired from clinical medicine, I still believe that is not a good approach. Also, the T waves in the first ECG - though not very impressive - were becoming more symmetrical and beginning to peak.<br /><br />Thanks!Jerry W. Jones, MD FACEP FAAEMhttps://www.blogger.com/profile/10333187745825224414noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-25146504021577650182018-04-22T19:37:44.250-05:002018-04-22T19:37:44.250-05:00I do think so, but that is difficult to see. The ...I do think so, but that is difficult to see. The PR interval is objective.Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-6992026051236986302018-04-22T19:35:33.279-05:002018-04-22T19:35:33.279-05:00Thanks, Ken!Thanks, Ken!Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-80617648378795022742018-04-22T16:55:35.620-05:002018-04-22T16:55:35.620-05:00Do you think that the differences in V4 and V5 are...Do you think that the differences in V4 and V5 are relevant?...<br /><br />The decrease in R wave amplitud or that the T waves are more peaked?<br /><br />ThanksAnonymoushttps://www.blogger.com/profile/07923939190940169560noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-6775266546320372012018-04-22T16:04:50.215-05:002018-04-22T16:04:50.215-05:00HypokalemiaHypokalemiamarionurse44https://www.blogger.com/profile/16626131022287119664noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-30088494903077830722018-04-22T15:53:34.656-05:002018-04-22T15:53:34.656-05:00NICE pickup by Dr. Smith that the PR interval in t...NICE pickup by Dr. Smith that the PR interval in the 1st ECG is longer (than it was when serum K+ was normal) — as an objective sign of hyperkalemia. I found myself going back-and-forth multiple times comparing lead-to-lead between these 2 tracings. I DO think there is a difference — namely that the peak of many T waves in the 1st ECG are slightly more pointed (specifically in leads I, II, and in each of the chest leads). This is subtle … but together with the increase in PR interval, I believe it DOES support prediction of a probable slight increase in serum K+ level from assessment of this initial ECG. The helpful clinical point — is that these patients often WILL be back (!), as many of them are frequent visitors to the hospital near where they reside. Many of these patients tend to have a “repetitive pattern” — in that their ECG manifests certain characteristic features they they develop when having exacerbation of a chronic condition (be that recurrent ischemia and/or hyperkalemia). Clinicians who regularly work at institutions where these patients frequent can “get to know their ECG” — and I found that when I was in practice, such familiarity often allowed me to immediately recognize subtle ECG changes in comparison to previous tracings that otherwise would have gone unnoticed. So the NEXT time this particular patient returns to the ED with slight increase in serum K+ — it should be that much EASIER to quickly recognize this from repeat ECG. THANKS to Dr. Smith for presenting this interesting case!ECG Interpretationhttps://www.blogger.com/profile/02309020028961384995noreply@blogger.com