Abstract
Dialysis patients are known to tolerate high potassium due to the chronic hyperkalemia that is inherent in their disease. Despite this, most reports of extremely high potassium (>9 mmol/L) are in the setting of cardiac arrest. We describe the case of a 57-year-old Caucasian male with past medical history significant for end stage renal disease known to be non-adherent to a low potassium diet as well as missed dialysis appointments. Stat potassium off of a basic metabolic panel was 10.2 mmol/L, which was non-hemolyzed and confirmed on repeat testing. A stat EKG was performed which revealed peaked T waves, mildly increased PR interval (200 ms), and mild QRS widening (142 ms). There was no evidence of bradycardia or sinusoidal wave form. The patient received emergent dialysis and his EKG normalized.
Highlights
We describe the case of a 57-year-old Caucasian male with past medical history significant for end stage renal disease known to be non-adherent to a low potassium diet as well as missed dialysis appointments
There was no evidence of bradycardia or sinusoidal wave form
End stage renal disease (ESRD) patients are known to tolerate hyperkalemia with less EKG changes as well as less life-threatening arrythmias leading to cardiac arrest
Summary
End stage renal disease (ESRD) patients are known to tolerate hyperkalemia with less EKG changes as well as less life-threatening arrythmias leading to cardiac arrest. Our patient is a 57-year-old Caucasian male with past medical history significant for end stage renal disease secondary to multiple myeloma and light chain deposition disease. He has a history of non-adherence to a low potassium diet and missed dialysis appointments. The patient had previously stated that he can “feel” when his potassium is too high, especially when he has lower extremity weakness, and he presents to the hospital when these symptoms are significant Previous to this episode he has tolerated extremely high potassium up to 9.0 mmol/L with only mild EKG changes (Figure 1). He underwent emergent dialysis and both his mental status and EKG normalized (Figure 2) (Table 1)
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