Abstract
Background: A sine-wave pattern in electrocardiography (ECG) is one of the manifestations of severe hyperkalemia and requires rapid medical intervention and urgent hemodialysis. This manifestation has high specificity for detecting hyperkalemia, and rapid medical intervention is required upon first medical contact. Case Description: A 60-year-old woman presents to the emergency room with generalized weakness that started around two days ago, and became increasingly more severe and noticeable to the point that the patient went to the emergency department. The patient initially was stable and experienced no other complaints including chest pain or dyspnea. A 12-lead ECG was obtained which showed the sine-wave morphology. Minutes later, the patient rapidly deteriorated and underwent cardiac arrest while waiting for lab results to confirm the hyperkalemia. The patient was resuscitated successfully and lab results confirmed potassium levels of 9.7mmol/L and a creatinine level of 9.55mg/dL (estimated GFR using CKD-EPI formula of 4 ml/min/1.73m2. The patient underwent potassium correction therapy with fast-acting insulin agents, dextrose and calcium gluconate infusions. A secondary ECG post ROSC and potassium correction therapy was taken, showing a reversal of the sine-wave pattern into an accelerated junctional rhythm with tall T waves. Chest X-ray was performed and showed cardiomegaly, and the patient was admitted into the ICU to undergo urgent hemodialysis. Conclusion: This case further emphasizes the importance of recognizing ECG manifestations of hyperkalemia and rapid management after recognition of said ECG patterns to prevent the clinical deterioration of the patient and potentially fatal outcomes should be undertaken as soon as possible.
Published Version
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