Slide 1: You arrive at a rapid response code and a colleague hands you this EKG. [EKG] What’s your diagnosis?

Slide 2: See a sine wave pattern on the strip? [EKG] Think hyperkalemia! (This patient’s K was 7.3 mEQ/L!)

Slide 3: What are your not-to-miss next steps?

Slide 4: 1. Calcium gluconate (stat!): Most important step for immediate cardiac protection! *if a central line is in place, consider using calcium chloride, which contains more calcium per unit. 2. Drive K+ into cells: Insulin (+ glucose), bicarbonate, albuterol. 3. Drive K+ out of body: Loop diuretics, laxatives, dialysis

Slide 5: Status-post calcium, bicarbonate, and hemodialysis: [EKG] Much improved!

Slide 6: A caveat for all of us bookworms: “textbook” EKG findings of hyperkalemia include: peaked T waves, slowed PR QRS intervals, heart block, sine wave, PEA. While cool, these are not sensitive for elevated potassium levels.

Slide 7: Got any cool EKGs? Email us at with your learning byte!


  • Montague BT, Ouellette JR, Buller GK. Retrospective review of the frequency of ECG changes in hyperkalemia. Clin J Am Soc Nephrol. 2008 Mar;3(2):324-30. Epub 2008 Jan 30. PMID 18235147

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