Daniel B. Petrov, M.D.N Engl J Med 2012; 366:1824 May 10, 2012
A 62-year old man with chronic renal insufficiency reported having reduced exercise tolerance for the previous week. The physical examination was unremarkable, but oxygen saturation was diminished. An electrocardiogram showed a regular rhythm, with a widened QRS complex in a sine-wave configuration, and there were no discernible P waves.
The T waves were fused with the widened QRS complexes (Panel A) to form the sine-wave pattern (sinoventricular rhythm), raising suspicion of severe hyperkalemia. The patient’s serum potassium level was 9.1 mmol per liter. His condition stabilized after the administration of calcium chloride, bicarbonate, glucose, and insulin therapy, which was followed by hemodialysis. Serial electrocardiograms showed progressive narrowing of the QRS complex.
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