• Maintain vigilance for hyperkalemia during electrocardiogram (EKG) examination. Proficiency in the identification of hyperkalemia through EKG analysis saves lives.

• Initiate intravenous calcium administration promptly without awaiting potassium level results if any suspicious EKG changes.

• Hyperkalemia induces a spectrum of EKG alterations, progressively escalating to severe arrhythmias as serum potassium concentration rises.

Image source: Liftl.com

• The chronological order of these Hyperkalemia-induced EKG changes isn’t necessary.

• I discussed the management of acute hyperkalemia right here:How to manage acute hyperkalemia in real-world inpatient settings

Example (1):

Image source: Dr.Sam Ghali X profile.

Wide complex tachycardia caught on the monitor, isn’t fast enough to be called V-tach. This is a classic example of Sine waves secondary to severe hyperkalemia.

Example (2):

Image source: X platform

Peaked T wave is the earliest manifestation of Hyperkalemia, they are sharp, narrow, symmetrical, and pointed as we see in this EKG.

Example (3):

Image source: X platform

Junctional escape rhythm with peaked T-waves secondary to critical hyperkalemia

Example (4):

Image source:  Dr.Sam Ghali X profile.

Wide complex tachycardia with LBBB secondary to critical hyperkalemia. Verify if this LBBB is present at baseline or not with any available old EKG. If this is a cute or New, Hyperkalemia should be considered along with ACS, the history and recent labs can be very helpful here.

Example (5):

Image source: Dr. Sam Ghali X platform account.

Classic Hyperkalemia-induced peaked T-wave, group beating is noticed here with no obvious P wave.

Example (6):

Image source: X platform

Wide complex tachycardia, ST elevation, and peaked T-wave in V1, V2, V3. The history and recent labs can be critical in guiding further treatment here! Giving IV calcium and activating the cath lab may both be necessary if the history is indecisive.

Example (7):

Image source: X platform.

Wide Bizzare QRS complexes along with peaked T-wave. Whenever you see bizarre-looking QRS, think of hyperkalemia and promptly administer IV calcium.

Example (8):

Wide QRS tachycardia with peaked T-waves (Sine waves) secondary to critical hyperkalemia.

In the end,

keep hyperkalemia in your mind whenever reviewing an EKG, you will save lives!