1. EKG’s & Electrolytes Steven W. Harris MHS, PA-C Lock Haven University

3. The Players Potassium Calcium You Me Your patient

4. Hyperkalemia EKG manifestations Causes Signs Symptoms Treatment

5. Hyperkalemia EKG manifestations!

6. Hyperkalemia Early EKG Manifestations: T wave: increased amplitude & peaking Later EKG manifestations: Prolonged PR interval widened QRS complex Flattening of the P wave

7. Serum K+ 8.1mEq/L

8. Hyperkalemia Causes!

9. Causes of Hyperkalemia Renal failure Excess potassium replacement ACE inhibitors Aldosterone antagonists Hypoaldosteronism Acidosis Addison’s Disease

10. Hyperkalemia Signs and Symptoms!

11. Signs and Symptoms of Hyperkalemia Arrhythmia Cardiac arrest Numbness, tingling, weakness Flaccid paralysis

12. Hyperkalemia Treatment!

13. Treatment of Hyperkalemia Treat underlying cause Calcium gluconate Insulin/glucose Kayexalate

14. Hypokalemia EKG manifestations Causes Signs Symptoms Treatment

15. Hypokalemia EKG manifestations!

16. Hypokalemia T wave flattening or inversion Increased prominence of U wave ST segment depression Ventricular ectopy Sustained tachyarrhythmias

18. Hypokalemia Causes!

19. Causes of Hypokalemia Liver cirrhosis Vomiting/diarrhea Diuretics Cushings or primary Aldosteronism

20. Hypokalemia Signs and Symptoms!

21. Hypokalemia Ventricular arrhythmias Hypotension Cardiac arrest Malaise, muscle weakness, cramps Carpopedal spasm, tetany Ileus Polyuria, nocturia, hyperglycemia

22. Hypokalemia Treatment!

23. Treatment of Hypokalemia Treat underlying cause Oral potassium therapy IV potassium therapy

24. Hypercalcemia EKG manifestations Causes Signs Symptoms Treatment

25. Hypercalcemia EKG manifestations!

26. Hypercalcemia QT interval is shortened ST segment may disappear PR may become prolonged. QRS may become prolonged

27. Calcium = 15 Calcium = 10.7

28. Hypercalcemia Causes!

29. Causes of Hypercalcemia Malignancy Renal Failure Hyperparathyroidism Hyperthyroidism Sarcoidosis Excessive Vitamin D ingestion

30. Hypercalcemia Signs and Symptoms!

31. Hypercalcemia Anorexia Nausea Constipation Polydipsia Polyuria Lethargy, stupor, coma Orthostasis

32. Hypercalcemia Treatment!

33. Treatment of Hypercalcemia Treat underlying cause Isotonic Saline for volume repletion Loop diuretics

34. Hypocalcemia EKG manifestations Causes Signs Symptoms Treatment

35. Hypocalcemia EKG manifestations!

36. Hypocalcemia Prolonged QT intervals May find T wave inversion

38. Hypocalcemia Causes!

39. Causes of Hypocalcemia Hypoparathyroidism Vitamin D deficiency Renal failure Hypoalbuminemia Pancreatitis Pseudohypoparathyroidism Sepsis

40. Hypocalcemia Signs and Symptoms!

41. Hypocalcemia Chvostek’s sign Trouseau’s sign Carpopedal spasm Tetany N/V/D Nervousness, Weakness Paresthesia’s, Stiffness, Muscular cramps, Headaches

42. Hypocalcemia Treatment!

43. Treatment of Hypocalcemia Treat underlying causes Calcium replacement Calcium gluconate Calcium chloride Vitamin D replacement