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Diagnosis of hyperkalemia by electrographic changes
Hyperkalemia is believed to cause characteristic changes in the ECG. But is it possible to diagnose hyperkalemia by ECG changes? The ECGs of 40 dogs and cats with a manifest hyperkalemia were evaluated and showed surprising results...

Eighteen dogs and 22 cats with serum potassium levels >5.5 mEq/L as the result of various disease processes were included in this prospective study.

Once hyperkalemia was documented, the following data were collected:
ECG (n=40), total magnesium (mg/dl) (n=18), total calcium (mg/dl) (n=31), and venous blood gas (n=20).

Animals were divided into 5 groups based on expected ECG`s changes associated with hyperkalemia (mEq/L): Group 1- 5.5-6.5; Group 2- 6.6-7.0; Group 3- 7.1-8.5; Group 4- 8.6-10.0; Group 5- >10.0.

ECG`s were interpreted to determine if the rate, rhythm and changes in the P-QRS-T complex were similar to those previously reported.

Results: Twelve ECGs demonstrated changes previously described, while 28 did not: Group 1 (n=7)- 1/7; Group 2 (n=2)- 0/2; Group 3 (n=14)- 4/14; Group 4 (n=6)- 3/6; Group 5 (n=11)- 4/11.

Many ECG abnormalities not previously described were also identified such as atrioventricular dissociation and ventricular tachyarrhythmias. Blood gas analysis revealed acidemia (19/20) with severe acidemia (pH<7.2) in the majority (16/19).

Hypocalcemia was documented (5/13) and most of these patents (4/5) were in Group 5.

Hypermagnesemia was documented in the majority of patients (10/18), though not in one particular group.

It is difficult to establish typical ECG changes in patients with hyperkalemia, which represents a departure from the historical description.

Hypocalcemia may be involved with ECG changes and arrhythmias in Group 5.
Hypermagnesemia causes electrocardiographic abnormalities similar to those described with hyperkalemia and therefore does not explain the results of this study.

There likely are complex interactions with electrolytes and acid base abnormalities that affect ECG formation.



Source: Tag, TL & Day, TK (2004)
ELECTROCARDIOGRAPHIC ASSESSMENT OF HYPERKALEMIA IN DOGS AND CATS. In: Journal of Veterinary Emergency and Critical Care 14 (S1), S1-S17.




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