ekg’s & electrolytes steven w. harris mhs, pa-c lock haven university
TRANSCRIPT
EKG’s & ElectrolytesEKG’s & ElectrolytesSteven W. Harris MHS, PA-C
Lock Haven University
The PlayersThe Players
PotassiumCalciumYou Me Your patient
HyperkalemiaHyperkalemia
EKG manifestationsCauses SignsSymptomsTreatment
HyperkalemiaHyperkalemia
EKG manifestations!
HyperkalemiaHyperkalemia
Early EKG Manifestations:T wave: increased amplitude & peaking
Later EKG manifestations:Prolonged PR intervalwidened QRS complexFlattening of the P wave
Serum K+8.1mEq/L
HyperkalemiaHyperkalemia
Causes!
Causes of HyperkalemiaCauses of Hyperkalemia
Renal failureExcess potassium replacementACE inhibitorsAldosterone antagonistsHypoaldosteronismAcidosis Addison’s Disease
HyperkalemiaHyperkalemia
Signs and Symptoms!
Signs and Symptoms of Signs and Symptoms of HyperkalemiaHyperkalemia
ArrhythmiaCardiac arrestNumbness, tingling, weaknessFlaccid paralysis
HyperkalemiaHyperkalemia
Treatment!
Treatment of HyperkalemiaTreatment of Hyperkalemia
Treat underlying cause
Calcium gluconate
Insulin/glucose
Kayexalate
HypokalemiaHypokalemia
EKG manifestationsCauses SignsSymptomsTreatment
HypokalemiaHypokalemia
EKG manifestations!
HypokalemiaHypokalemia
T wave flattening or inversion Increased prominence of U waveST segment depressionVentricular ectopySustained tachyarrhythmias
HypokalemiaHypokalemia
Causes!
Causes of HypokalemiaCauses of Hypokalemia
Liver cirrhosisVomiting/diarrheaDiureticsCushings or primary Aldosteronism
HypokalemiaHypokalemia
Signs and Symptoms!
HypokalemiaHypokalemia
Ventricular arrhythmiasHypotensionCardiac arrestMalaise, muscle weakness, crampsCarpopedal spasm, tetany IleusPolyuria, nocturia, hyperglycemia
HypokalemiaHypokalemia
Treatment!
Treatment of HypokalemiaTreatment of Hypokalemia
Treat underlying cause
Oral potassium therapy
IV potassium therapy
HypercalcemiaHypercalcemia
EKG manifestationsCauses SignsSymptomsTreatment
HypercalcemiaHypercalcemia
EKG manifestations!
HypercalcemiaHypercalcemia
QT interval is shortened
ST segment may disappear
PR may become prolonged.
QRS may become prolonged
Calcium = 15
Calcium = 10.7
HypercalcemiaHypercalcemia
Causes!
Causes of HypercalcemiaCauses of Hypercalcemia
MalignancyRenal FailureHyperparathyroidismHyperthyroidismSarcoidosisExcessive Vitamin D ingestion
HypercalcemiaHypercalcemia
Signs and Symptoms!
HypercalcemiaHypercalcemia
AnorexiaNauseaConstipationPolydipsiaPolyuriaLethargy, stupor, comaOrthostasis
HypercalcemiaHypercalcemia
Treatment!
Treatment of HypercalcemiaTreatment of Hypercalcemia
Treat underlying cause
Isotonic Saline for volume repletion
Loop diuretics
HypocalcemiaHypocalcemia
EKG manifestationsCauses SignsSymptomsTreatment
HypocalcemiaHypocalcemia
EKG manifestations!
HypocalcemiaHypocalcemia
Prolonged QT intervalsMay find T wave inversion
HypocalcemiaHypocalcemia
Causes!
Causes of HypocalcemiaCauses of Hypocalcemia
HypoparathyroidismVitamin D deficiencyRenal failureHypoalbuminemia Pancreatitis PseudohypoparathyroidismSepsis
HypocalcemiaHypocalcemia
Signs and Symptoms!
HypocalcemiaHypocalcemia
Chvostek’s sign Trouseau’s sign Carpopedal spasm Tetany N/V/D Nervousness, Weakness Paresthesia’s, Stiffness, Muscular cramps,
Headaches
HypocalcemiaHypocalcemia
Treatment!
Treatment of HypocalcemiaTreatment of Hypocalcemia
Treat underlying causesCalcium replacement
Calcium gluconateCalcium chloride
Vitamin D replacement