IV2V4 1a = Talk and peak Y wave. 1b = Narrow T wave. 1c = slur J point Hyperkalemia (Case 1). Pattern of stage 1. Patient. 41 yo diabetic female on chronic peritoneal dialysis admitted with diabetic ketoacidosis. Her initial potassium level was 6.6
>5.5 mM - T wave.
- Tall and peak (1a) with narrow T wave (1b)
- ST segment is concaved
- Slur J point (1c)
- Occurs in 1/4 of hyperkalemia patient.
>6.5 mM - QRS change.
- Widening of both initial and terminal portion due to slow conduction in the ventricles.
- Progressive widening with higher serum K+ level and may reach dying heart pattern.
- There is only rough correlation between K+ level and QRS width.
>7.0 mM - P wave
- Amplitude decreases and duration increases due to slower conduction in the atria.
- Invisible when K+ is >8.0 mM (Sinoventricular conduction or displacement of the pacemaker into junctional or Purkinje fibers).
Stage 4 . >10.0 mM - Irregular wide QRS rhythm Stage 5 . 12-14 mM - Ventricular asystole or ventricular fibrillation Go to Differential diagnosis of tall and peak T wave
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