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I V2 V4 | |
| 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 | |
Stage 1 >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. |
Stage 2 >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. |
Stage 3 >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 |
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