Electrolyte Disorders: Difference between revisions

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==Hypercalcemia==
==Hyperkalemia==
Hypercalcemia results in a faster repolarization. Characteristics of hypercalcemia:
ECG characteristics of hyperkalemia, high blood potassium:
*mild: broad based tall peaking T waves
*P-waves are widened and of low amplitude due to slowing of conduction
*severe: extremely wide QRS, low R wave, disappearance of p waves, tall peaking T waves.
*QRS complex:
 
**QRS widening
==Hypocalcemia==
**fusion of QRS-T
ECG-characteristics of hypocalcemia:
**loss of the ST segment
*narrowing of the QRS complex
*Tall tented T waves
*reduced PR interval
*T wave flattening and inversion
*prolongation of the QT-interval
*prominent U-wave
*prolonged ST and ST-depression


==Hyperkalemia==
The initial part of the QRS complex is often spared as purkinje fibers are less sensitive to hyperkalemia.
[[Image:ecg_hyperkaliemie.jpg|thumb| Extreme hyperkalemia. No p-waves, wide QRS, tall peaking T waves.]]
These changes can also occur in acidosis (via the same mechanism) and during Class IC anti-arrhythmic intoxication.
[[Image:ecg_hyperkaliemie2.jpg|thumb| Same patient after partial correction of the potassium level. Still no p-waves visible, wide QRS, tall peaking T waves.]]
ECG characteristics of hyperkalemia:
*Tall peaked T waves
*Flattening p-waves. In extreme hyperkalemia p-waves may disappear altogether.
*Prolonged depolarization leading to QRS widening (nonspecific intraventricular conduction defect) sometimes > 0.20 seconds


At concentrations > 7.5 mmol/L atrial and [[Ventricular Fibrillation|ventricular fibrillation]] can occur.
At concentrations > 7.5 mmol/L atrial and [[Ventricular Fibrillation|ventricular fibrillation]] can occur.
<gallery consecutive ECGs of a patient with severe hypokalemia>
Image:KJcasu18-3.jpg|Consecutive ECGs of a patient with hyperkalemia. ECG1
Image:KJcasu18-2.jpg|Consecutive ECGs of a patient with hyperkalemia. ECG2
Image:KJcasu18-1.jpg|Consecutive ECGs of a patient with hyperkalemia. After correction of potassium levels. ECG3
File:DVA0578.jpg|Another patient, potassium of 9.4 mmol/L
File:E000561.jpg|Potassium 7.5 mmol/L. [[Answer_-_Case_of_the_month_(Oct_2011)|More ECGs]]
</gallery>
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==Hypokalemia==
==Hypokalemia==
Hypokalemia, low blood potassium, results in:
*ST depression and flattening of the T wave
*Negative T waves
*A U-wave may be visible
<gallery>
<gallery>
Image:Hypokalemia.jpg| A patient with hypokalemia, prominent QT prolongation. Not the extrasystoles originating from the prolonged T/U wave. This patient definitely needs rhythm monitoring
Image:KJcasu17-1.jpg| patient A
Image:KJcasu17-1.jpg| patient A
Image:KJcasu17-2.jpg| patient A
Image:KJcasu17-2.jpg| patient A
Image:KJcasu17-3.jpg| patient B
Image:KJcasu17-3.jpg| patient B
Image:JJ0003.jpg| Patient C, Potassiumlevel of 1.5
</gallery>
</gallery>
Hypokalemia is a low blood potassium level. This results in:
*ST depression and flattening of the T wave
*Negative T waves
*A U-wave may be visible
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==Hypercalcemia==
Hypercalcemia, high blood calcium, speeds repolarization. Characteristics of hypercalcemia:
*Mild: broad based tall peaking T waves
*Severe: extremely wide QRS, low R wave, disappearance of p waves, tall peaking T waves.
<gallery>
File:E000546.jpg|A patient with severe hypercalcemia: Calcium 4.6 mmol/L, albumin 37 g/L
</gallery>
==Hypocalcemia==
ECG-characteristics of hypocalcemia, low blood calcium:
*Narrowing of the QRS complex
*Reduced PR interval
*T wave flattening and inversion
*Prolongation of the QT-interval
*Prominent U-wave
*Prolonged ST and ST-depression
<gallery>
File:E000800.jpg|An ECG of a patient with hypocalcemia
</gallery>
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