ECG & electrolytes disturbance

• Q/What’s the main significance of ECG paper in any patient with electrolyte disturbance ??

HyperK+

Normal serum K+ 3.5-5 mmol/lHyperk+ Cause flaccidation of heart m. & may lead

cardiac arrest if the level exceed 7mmol/l

Causes of hyperk+1.Increase intake

a.During correction of hypoK+b.food(banana)

C.drugs??2.Impaired excretion of K+

a.Acute & chronic renal failureb.Circulatory failure (reduce renal perfusion)c.Addison diseased.Long standing use of B.blockerse.ACEIf.NSAID

3.Shift of K+ from intra to extracellular compartment a.Sever leg ischemia … hypoxia

b.DKAc.ADH deficiency … water depletiond.Aspirin poisoning (acidosis)hemolytic anemia , leukemia ,MM

Clinical features ??? Tingling sensation over lips &mouth, M weakness,loss of tendon reflex,abdominal distention,collapse

PseudohyperK+ ??? Occur due to destruction of RBCs in delayed investigated blood sample

ECG changes :

1.Prolong PR interval(more than 5 small boxes)2.Prolong QRS complex(more than 3 small boxes)3.Tall tented T wave 4.Some times loss of P wave

RX of hyperK???+1.Role of 10 10 10 : 10ml of 10% Ca gluconate IV for 10 min.2. 50%hypertonic glucose+IV Insuline *in non diabetic Pt3. Nabicarbonate for metabolic acidosis4. If there’s no response do hemodialysis**prophylaxis**1. 10% dextrose solution2. Calcium resin

HypoK+Causes:

1.Reduce intake2.loss from GIT

a.vomiting&diarheab.Bowl fistulac.Vellous adenoma

3.Loss in urine a.DKAb.Cushing s.c.Conn’s s.d.Renal tubular acidosis(K+ exchanged w Na instead of H+ )

• Clinical feature of hypoK+ ???• M.weakness(unable to walk upstairs),in sever

cases : paralysis&renal tubular damage

• ECG changes :• 1.flattened T wave• 2.presence of U waves (in most of leads)• 3.ST depression( in sever cases)

• **most of Pt with hypoK+ my associate with ventricular ectopi ,SVT or Af on ECG

• RX of hypoK+???

1. In mild moderate cases give oral KCl 3_4 gm/day Or give fruit juice2. In sever cases give IV KCl 100mmol/day

HyperCa++

• Normal serum Ca++ 2.1-2.6 mmol/l• imp(8.5-10.5 mg/dl)

• 99% Vs 1%

• Calcium regulator ??

• Causes of hyperCa++ :• 1.with high PTH• a.primary or tertiary hyperparathyroidism• b.familial hypercalciuric hypercalcemia(AD)• 2.with low PTH• a.milk alkali syndrome • b.thiazid diuretic• c.breast ovarian colon thyroid CA• d. MM• e. Paget’s disease of bone• f. vit D intoxication• g. recumbency

• Clinical features ???• CNS:lethargy• GIT:nausea , vomiting ,constipation , abd. Pain, peptic

ulcer• Urinary:polyurea , polydipsia , kidney stone

• ** in chronic HyperCa … Pt present with traid: Hypertension , Hyperchloremia , Hyperuricemia

• ECG changes :

• Short QT interval• Normal QT ??

• Rx of hyperCa++ ???• 1. 0.9% normal saline in first 24 hr• 2. frusemide 40mg• 3. calcitonin(shift Ca from plasma to bone)• 4. pamidronate(bisphosphonate : inhibit bone

resorption)• 5. prednisolone• 6. if there’s no response do hemodialysis

hypoCa++

• Causes :• 1. respiratory or metabolic alkalosis• 2. vit D deficiency• 3.chronic renal failure• 4.Hypoparathyroidism• 5. hypoalbonemia• 6.hypoparathyroidism• 7.pseudohypoparathyroidism• 8.acute pancreatitis

• Clinical features ???• In young Pt : carpopedal spasm,laryngeal spasm,convulsion• In old Pt : tingling sensation around mouth&finger+ -

carpopedal spasmif spasm not obvious ,, we can make it clear by ::

Trousseau’s sign

Chvostek’s sign

• ECG changes :• Prolong QT interval

Rx of HypoCa++???

1. Correct alkalosis by rebreathing bag or 5% Co2 along with O2

2. Role of 10 10 103. If no response give Ca chloride or Mg

chloride4. 1alpha cholecalciferole or

1.25 dihydrocholecalceferole

•Assessment•60 years old male in CCU on continuous

diuretics & digoxin for his CHF , the patient gradually develop cardiac (arrhythmia)..

•What do you suspect electrolyte disturbance if you didn’t see monitor???