ECG: Hypokalemia

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ECG: Hypokalemia

  1. 1. PROF.DR. G.SUNDARAMURTHY’S UNIT – M5
  2. 2. <ul><li>ECG OF THE WEEK </li></ul><ul><li>Prof. G Sundaramurthy’s Unit </li></ul><ul><li>P.Vanjinathan </li></ul>
  3. 3. <ul><li>52 yrs old male, </li></ul><ul><li>C/o Loose stools X 4 days </li></ul><ul><ul><li>8-10 episodes/day, watery </li></ul></ul><ul><ul><li>assc. vomiting + </li></ul></ul><ul><ul><li>No blood/mucus/tenesmus </li></ul></ul><ul><li>H/o Vomiting + </li></ul><ul><ul><li>4 – 5 episodes/day </li></ul></ul><ul><ul><li>Colourless, watery, non-bilious, no blood </li></ul></ul><ul><ul><li>H/o Fatiguability + </li></ul></ul><ul><ul><li>H/o Cramps + </li></ul></ul>
  4. 4. <ul><li>ON EXAMINATION: </li></ul><ul><li>Pulse– 76 per min </li></ul><ul><li>BP---100/70mmHg </li></ul><ul><li>RR---16per min </li></ul>
  5. 5. ECG
  6. 7. <ul><li>HR - 70/min </li></ul><ul><li>Rhythm - Normal sinus rhythm </li></ul><ul><li>PR interval - 0.12 sec </li></ul><ul><li>P wave - Normal morphology </li></ul><ul><li>QRS interval - 0.08 sec </li></ul><ul><li>QT interval - Prolonged </li></ul><ul><li>QRS Voltage - Normal </li></ul><ul><li>QRS axis - Normal axis </li></ul><ul><li>R wave progression - Normal </li></ul>
  7. 8. <ul><li>Abnormal Q wave - No abnormal Q wave </li></ul><ul><li>ST segment - Depression in V 3 -V 6 </li></ul><ul><li>T wave - Amplitude decreased </li></ul><ul><li>U wave - Seen in L Ӏ I , L Ӏ II ,aVF,V 2 -V 6 </li></ul>
  8. 9. INVESTIGATIONS <ul><li>CBC--- NORMAL </li></ul><ul><li>URINE ROUTINE---NORMAL </li></ul><ul><li>RFT---UREA- 30mgs/dl </li></ul><ul><li>CREAT-0.9mgs/dl </li></ul><ul><li>ELECTROLYTES---Na---128meq </li></ul><ul><li>K----2.7meq </li></ul>
  9. 10. ECG Changes in Hypokalemia <ul><li>Early changes : </li></ul><ul><ul><li>Flattening or inversion of T waves </li></ul></ul><ul><ul><li>Prominent U waves </li></ul></ul><ul><ul><li>ST segment depression </li></ul></ul><ul><ul><li>Prolonged QT interval </li></ul></ul><ul><li>Severe Potassium depletion: </li></ul><ul><ul><li>Prolonged PR interval </li></ul></ul><ul><ul><li>Decreased voltage of QRS </li></ul></ul><ul><ul><li>Widening of QRS complex </li></ul></ul><ul><ul><li>Ventricular arrhythmia </li></ul></ul>
  10. 11. Causes of Hypokalemia <ul><li>Decreased intake </li></ul><ul><li>Redistribution into cells </li></ul><ul><ul><li>Acid base - Metabolic acidosis </li></ul></ul><ul><ul><li>Hormonal – Insulin, β 2 agonist, α -Antagonist. </li></ul></ul><ul><ul><li>Anabolic state – B 12 / Folic acid supplements </li></ul></ul><ul><ul><li>Others – Pseudohypokalemia, Hypothermia, Hypokalemic periodic paralysis </li></ul></ul>
  11. 12. <ul><li>Increased Loss </li></ul><ul><ul><li>Non renal - GI loss, Integumentary loss (sweat) </li></ul></ul><ul><ul><li>Renal - </li></ul></ul><ul><ul><ul><li>Increased distal flow : diuretics, osmotic diuresis, salt-wasting nephropathies </li></ul></ul></ul><ul><ul><ul><li>Increased secretion of potassium: </li></ul></ul></ul><ul><ul><ul><ul><li>Mineralocorticoid excess : Primary hyperaldosteronism, Secondary hyperaldosteronism (malignant hypertension, Renin-secreting tumors, Renal artery stenosis, Hypovolemia), Congenital adrenal hyperplasia, Cushing's syndrome, Bartter's syndrome </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Distal delivery of non-reabsorbed anions : vomiting, NG suction, proximal (type 2) RTA, DKA, penicillin derivatives </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Others: Amphotericin B, Liddle's syndrome, Hypomagnesemia </li></ul></ul></ul></ul>
  12. 13. CLINICAL FEATURES <ul><li>Neuromuscular : Fatigue, myalgia, and muscular weakness of the lower extremities. </li></ul><ul><ul><li>Smooth muscle involvement – Constipation, ileus, urinary retention </li></ul></ul><ul><ul><li>progressive weakness, hypoventilation (due to respiratory muscle involvement), and eventually complete paralysis </li></ul></ul><ul><li>Impaired ability of kidneys to concentrate urine – Polyuria, urine with low osmolality, polydipsia </li></ul><ul><li>GI manifestations : </li></ul><ul><ul><li>Anorexia, nausea, vomiting </li></ul></ul><ul><ul><li>Constipation, Abdominal distension, paralytic ileus </li></ul></ul><ul><li>CVS – Arrhythmias </li></ul><ul><li>Metabolic alkalosis </li></ul>
  13. 14. Treatment <ul><li>Correct volume depletion & Rx of underlying etiology </li></ul><ul><li>Estimate the K + deficit </li></ul><ul><ul><li>1 mEq/L = Total body K + deficit of 200 to 400 mEq </li></ul></ul><ul><li>If no ECG changes - start oral K + supplementation </li></ul><ul><li>If ECG changes present – Start I.V K + repletion </li></ul><ul><ul><li>Rate of < 20 mEq/hr </li></ul></ul><ul><ul><li>In peripheral vein < 40 mEq/L </li></ul></ul><ul><ul><li>In central vein < 60 mEq/L </li></ul></ul><ul><li>Monitor K + during therapy </li></ul><ul><li>Search for & Rx hypomagnesemia </li></ul>
  14. 15. Treatment Contd... <ul><li>Preparations Available </li></ul><ul><ul><li>Various salts of K + : Cl - , HCO 3 - , Phosphate & Gluconate salts </li></ul></ul><ul><ul><li>KCl : More effective in hypokalemia with metabolic alkalosis . (e.g. Diuretic usage, Diarrhea) </li></ul></ul><ul><ul><li>KHCO 3 / K Citrate : Hypokalemia & metabolic acidosis (e.g. RTA) </li></ul></ul>
  15. 16. THANK YOU

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