Electrolyte Induced EKG Changes

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Electrolyte Induced EKG

Changes

The EKG as a Instantaneous

Monitor of Critical Patients

The EKG as a Instantaneous

Monitor of Critical Patients

By Robert Ehrlich M.D. , F.A.C.C.

EKG Strips from American Academy of Pediatrics Silver Prize Winning Exhibition 1984

“The EKG as an Instantaneous Physiological Monitor”



Basics

• The Transmembrane Potential Changesproduce EKG

• K+, Na+ and Ca++ Fluxes cause the

changes• Abnormalities in these produce definitive

changes in EKG instantaneously

• Cardiac Function correlate to changes• Predisposition to Arrhythmias correlate

• Rx show changes immediately



Most Common Answer: V Tach

• Correct Answer:

– Wide Complex Tachycardia

• Ventricular Tachycardia Most Common in Adults

• Hyperkalemia

– Most common in critically ill pediatric

patients especially in infant non cardiac patient

– I presume this is cause in a noncardiac pediatric arrest

and very frequently in cardiac patients

Strip from an Adult with Ventricular Tachycardia

Notice in following EKG‟s same pattern with

HYPERKALEMIA



Continuous Strip

lasting one

minute showing

immediate effect

of a Bicarb push

There is a beat

by beat

improvement

from

hyperkalemia

towards normal

Analysis on next

slides



Chaotic rhythm with cyclic pattern becoming regular

cycle one cycle two cycle three

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Hyperkalemia being corrected by bicarb correcting

acidosis shifting K+ into cell reducing e/i ratio

QRS is wide T is tall and tented P not seen may be

in T because of prolonged PR interval

Second row pattern identical V-Tach seen earlier

First two rows about 10 seconds



Next 4 Rows about 40 sec

Beat by beat improvement as QRS narrows and T wave

diminishes Possible P seen buried in T in last row

Voltage of QRS is variable sometimes increasing or

decreasing as in this case



Classic HyperKalemia pattern of prolonged

PR interval Wide QRS T wave increase and

tented Normalizes as Insulin drives K+ into

cells. Glucose is to cover insulin



Acidosis shifts K+ out of cells

Alkalosis shifts K= into cells



Ca++ counters the effect of increasing K+

without directly changing K+ levels

This not only includes EKG changes but

functional improvement



Hypokalemia

T wave diminishes



Bundle Branch Block caused by hyperkalemia

corrected with NaBicarbonate

Beginning

End



Normally ST segment duration is less than T wave

In clinical situations such as rapid correction of acidosis where hypocalcemia is likely

presume low Ca++ if ST is longer than T



Monitor Strips

These were recorded but no action was taken.

Deterioration of patient should have been Rx „ed

at strip B

“ SURPRISE” Arrest occurred



Summary and Conclusion

2 THE CHANGES PRODUCE EKG COMPLEX VERIATIONS

3 THE VERIATION OCCURS THE INSTANT SIGNIFICANT CHANGES OCCUR

4 IN SITUATIONS WHERE VERIATIONS CAN OCUUR RAPIDLY

THE CONTINUOUS EKG CAN MONITOR FOR THE CHANGES

5 THERAPY CAN BE BASED ON THIS AND RESULTS SEEN IMMEDIATELY

6 EKG STRIPS ILLUSTRATE THE CHANGES AND RAPIDITY

7 EXPERIENCE UTILIZING PROTOCOL WHERE EKG FINDINGS DETERMINED

FREQUENCY OF EMERGENCY DRUG ADMINISTRATION IN CARDIAC

ARRESTS SHOWED HIGH SUCCESS RATE ATTRIBUTED TO TIMELYDOSING

1 ELECTROLYTE CONCENTRATIONS EFFECT CARDIAC DEPOLARIZATION

Electrolyte Induced EKG Changes

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