I have had a couple of good EKG’s in the setting of hyperkalemia that I thought I would share.

The first case is a 68 y/o female with ESRD on dialysis presenting with “back pain”.  Turns out that her back pain was actually chronic and at baseline, but she had missed her last two dialysis appointments.  She denied any chest pain or SOA.  I ended up getting an EKG while waiting on labs.

Initial EKG:

Previous EKG (~6 months ago)

What says you?  New onset LBBB?  After seeing this we gave Calcium Gluconate and asked one of our wonderful techs to grab a quick iStat as labs were taking forever to result.  Potassium was 6.8.  Gave insulin + D50 and bicarb.  EKG was repeated after Hyperkalemia treatment:

Renal consulted for emergent dialysis and medicine admitted.

Here’s another EKG that I had recently from a DKA patient who had an initial potassium of 7.8:

Here’s a couple of good hyperkalemia resources:

Hyperkalemia EKG Basics

Treatment of Hyperkalemia