Rhythm Nation June 2015 – Answer!

Congratulations Dr. Grundmann!

Rhythm Nation June '15

The ECG shows  T-wave inversions with prominent U-waves in leads V3-V6, and less prominent in leads II, II, aVF. The QT interval is also prolonged. All signs pointing towards hypokalemia. This patient’s potassium level of 2.3 mEq/L. With the patient’s history of weakness following exertion and his recent consumption of a large carbohydrate meal (two hints), this patient may have a condition called hypokalemic periodic paralysis (HPP).

Hypokalemia definition:

Mild: serum K+ < 3.5

Moderate: serum K+ < 3.0

Severe: serum K+ <2.5

ECG findings associated with hypokalemia:.

Diagnostics:

Management:

References:

Lu KC, Hsu YJ, Chiu JS, et al. Effects of potassium supplementation on the recovery of thyrotoxic periodic paralysis. Am J Emerg Med 2004;22:544

Tassone H, Moulin A, Henderson SO. The pitfalls of potassium replacement in thyrotoxic periodic paralysis: a case report and review of the literature. J Emerg Med. 2004;26(2):157.

Life in the Fast Lane: Hypokalemia. http://lifeinthefastlane.com/ecg-library/basics/hypokalaemia/.

Martindale, Jennifer and Brown, David. “Chapter 8. QT Abdnormalities and Electrolyte Disturbanc”. Rapid Interpretation of ECGs in Emergency Medicine. Philadelphia, PA: Lippincott Willimas & Williams, 2012.

 

The views expressed on this blog are the author's own and do not reflect the views of their employer. Please read our full disclaimer here. Any references to clinical cases refer to patients treated at a virtual hospital, Janus General Hospital.
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