Question

Case Example: A 68-year-old man with diabetes and chronic congestive heart failure who is prescribed digitalis and insulin presents to the emergency department with abdominal pain and cramping. Upon exam, the he is noted to have hyperactive reflexes. An ECG shows a prolonged PR interval, widened QRS and depressed ST segment.

1.What electrolyte imbalance is this patient most likely suffering from?

Answer 1

The electrolyte imbalance behind this patient presentation is: Hyperkalemia.

Explanation:

Hyperkalemia is an electrolyte variation from the norm found in the crisis office and also in hospitalized patients and it can be related with unfriendly clinical results and passing if not treated suitably. Remember that the electrophysiologic impacts of hyperkalemia are specifically relative to both the total plasma potassium and its rate of rise. In any case, neither the ECG nor the plasma potassium alone are a satisfactory record of the seriousness of hyperkalemia, and subsequently suppliers ought to have a low edge to start treatment. Great educating of the ordered ECG changes of hyperkalemia includes:

1. Peaked T waves
2. Prolongation of PR interval
3. Widening QRS Complex
4. Loss of P wave
5. "Sine Wave"
6. Asystole

Numerous people with hyperkalemia are asymptomatic. Whenever show, indications are nonspecific and transcendently identified with strong or cardiovascular capacity. Shortcoming and weariness are the most widely recognized protestations. Every so often, patients may report the accompanying:

• Frank muscle loss of motion
• Dyspnea
• Palpitations
• Chest torment
• Nausea or regurgitating
• Paresthesias
• Abdominal pain
• Cramping

All in all, the consequences of the physical examination alone don't caution the doctor to the finding of hyperkalemia, with the exception of when extreme bradycardia is available or muscle delicacy goes with muscle shortcoming, proposing rhabdomyolysis. Examination discoveries in patients with hyperkalemia incorporate the accompanying:

• Vital signs generally ordinary, with the exception of incidentally in bradycardia because of heart piece or tachypnea because of respiratory muscle shortcoming
• Muscle shortcoming and flabby loss of motion
• Depressed or missing profound ligament reflexes

At the point when hyperkalemia is found, examine potential pathophysiologic systems. Hyperkalemia can come about because of any of the accompanying, which frequently happen in blend:

• Excessive intake
• Decreased discharge
• A move of potassium from the intracellular to the extracellular space