ecg in electrolyte abnormalities.pptx
TRANSCRIPT
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ECG in
Electrolyte
AbnormalitiesThe faces of ECG series
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Potassium
Serum potassium level may be deceiving
o Acute changes are likely to lead to ECG changes
o
Chronic changes often result in no orminimal ECG changes
Correlation between potassium level and ECG
changes is unreliable
Sensitivity in detecting hyperkalaemia is low
Wrenn KD, Slovis CM, Slovis BS. The ability of physicians to predict hyperkalemia from the ECG. Ann Emerg Med 1991;20:1229-32.
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Case ExampleA 17yo girl is known to suffer
with anorexia nervosa, and
purgative misuse, presented
in ED as she complained shehad felt very weak, and had
not been able to get out of
bed.
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Case ExampleA 17yo girl is known to suffer
with anorexia nervosa, and
purgative misuse, presented
in ED as she complained shehad felt very weak, and had
not been able to get out of
bed.
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Case ExampleA 17yo girl is known to suffer
with anorexia nervosa, and
purgative misuse, presented
in ED as she complained shehad felt very weak, and had
not been able to get out of
bed.
Potassium 1.8mmol/L
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Hypokalaemia
D E F
T U
UT UT U
A B C
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HypokalaemiaLarge P wave T wave flattening Prominent U wave
ST depression
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Hypokalaemia
PR prolongation
QTc prolongation T wave often merges with U wave
Increased risk of VT
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Case Example62yo Maori woman with
DMT2. She is on dialysis
for CKD. 24hrs worsening
nausea and vomiting.She missed one session as
she briefly visited family
in New Zealand.
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Case Example62yo Maori woman with
DMT2. She is on dialysis
for CKD. 24hrs worsening
nausea and vomiting.She missed one session as
she briefly visited family
in New Zealand.
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Case Example62yo Maori woman with
DMT2. She is on dialysis
for CKD. 24hrs worsening
nausea and vomiting.She missed one session as
she briefly visited family
in New Zealand.
Potassium 8.1mmol/L
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Case Example53yo man DMT1, CKD on
dialysis. GCS 10. D2 post
dialysis next session
tomorrow. BSL >38mmol/L.Dry gangrene of toes and
middle finger.
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Case Example53yo man DMT1, CKD on dialysis. GCS 10. D2 postdialysis next session tomorrow. BSL >38mmol/L. Drygangrene of toes and middle finger.
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Case Example53yo man DMT1, CKD on dialysis. GCS 10. D2 postdialysis next session tomorrow. BSL >38mmol/L. Drygangrene of toes and middle finger. K 8.6mmolL
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Hyperkalaemia
Flat P wave Increased PR Wide QRS Peaked T wave
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HyperkalaemiaSine wave appearance
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Hyperkalaemia
Increased amplitude and peaking of T wave
QRS prolongation
PR prolongation P wave flattening
Loss of P wave
Sine wave appearance
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Case ExampleA 56yo woman has recently
had a bout of viral gastro she
had thyroidectomy 3 weeks
ago. She is fatigued, hasmuscle cramps in the arms
and tingling in the toes.
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Case ExampleA 56yo woman has recently had a bout of viral gastroshe had thyroidectomy 3 weeks ago. She is fatigued,has muscle cramps in the arms and tingling in thetoes.
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Hypocalcaemia QTc prolongation
Ca deficiency Prolonged QTc interval
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Hypocalcaemia Terminal T wave inversion
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Hypocalcaemia
QTc prolongation
ST segment prolongation
P wave normal PR interval normal
Rate usually not affected
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Case ExampleA 63yo Lao man with lung
cancer. He is complaining
of anorexia, nausea, poliuria
and polydipsia. He isconstipated too.
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Hypercalcaemia
QTc shortening Biphasic T wave
Osborn wave
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Hypercalcaemia
P and T waves usually unaltered
Ventricular fibrillation may occur in severehypercalcaemia
QT interval correlates with severity ofhypercalcaemia
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The End