![]() Both dogs and humans on verapamil have profoundly lower cardiac indexes when hyperkalaemic. I’m not sure is it the Ca2+ blocking effect worsening the hyperkalaemic effect on myocardium or the cumulative negative inotropy, but I can see a logical argument for empirical calcium therapy in those on verapamil and perhaps other calcium channel blockers. ![]() Patients with significant hyperkalemia (K+6. Furthermore it has been shown worsening stages of CKD tolerate any given level of hyperkalaemia better, again perhaps due to the rate of change. I could find no good study showing that ECG changes, except for sinusoidal waves, predicted death or morbidity. The long described progression of t wave changes through to QRS widening and then sinusoidal waves is a physiologically pleasing one, it feels right and is very logical. The ECG itself however, would seem not to be particularly useful in treating real patients, and I am going to force myself to ignore normal ECGs. I think my assessment of the urgency will centre around how the patient looks and the rate of flux, background CKD, serum K+, likelihood of rapid improvement, medications and cardiac history.Ī final point I stumbled across which I found interesting was the interaction between verapamil and hyperkalaemia. ECG manifestations of hyperkalemia- a medical emergency and treated urgently.
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