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Practical Nephrology pp 101–122Cite as

Common Electrolyte Disorders

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Abstract

Electrolyte abnormalities are extremely common in the hospital setting and are associated with considerable morbidity and mortality. While some aspects of physiology and therapy are controversial and complex, electrolyte abnormalities can be managed safely and effectively by reference to guidelines, applying basic principles consistently and monitoring closely.

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Author information

Authors and Affiliations

  1. UCL Centre for Nephrology, Royal Free Hospital, Pond Street, London, NW3 2QG, UK

    Antje Fürstenberg SpR, Stephen B. Walsh MBBS, PhD & Christopher M. Laing MBChB, MRCP, MD (Res)

Authors
  1. Antje Fürstenberg SpR
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  2. Stephen B. Walsh MBBS, PhD
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  3. Christopher M. Laing MBChB, MRCP, MD (Res)
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Corresponding author

Correspondence to Christopher M. Laing MBChB, MRCP, MD (Res) .

Editor information

Editors and Affiliations

  1. UCL Department of Nephrology, Royal Free London NHS Foundation Trust, London, United Kingdom

    Mark Harber

Appendix 1: Electrocardiogram Changes associated with Electrolyte Abnormalities

Appendix 1: Electrocardiogram Changes associated with Electrolyte Abnormalities

Hyperkalaemiaa

5.5–6.0 mmol/L Peaked T waves (especially leads II, III and V2-4) (T wave higher than R wave in more than one lead, also shortened QT).

6.0–7.0 mmol/L Increased PR interval

7.0–8.0 mmol/L Flattening of P waves, widening of QRS, bradycardia

>8.0 mmol/L P waves become invisible, fusion of QRS and T waves, VF, Sine wave, asystole

Hypokalaemia(below 2.7 mmol/L)

Flattened T waves, ST depression, QTc prolongation (risk of Torsades de pointes), U wave (Camel’s hump), atrial and ventricular ectopics and risk of supra and infraventricular arrhythmias below 3 mmol/L in predisposed individuals

Hypercalcaemia

Short QTc (<230 ms), in addition wide QRS complex, broad based and peaked T waves, ST depression and disappearance of P waves, bradycardia

Hypocalcaemia

Prolonged QTc (>440 ms), in addition narrow QRS complex, flat T waves reduced PR interval and U waves. Can develop heart block and prolonged QTc predisposes to Torsades de pointes

Hypermagnesaemia

Bradycardia and hypotension from 2 to 2.5 mmol/L, prolongation of PR interval from 2.5 mmo/L, broadened QRS complex, complete heart block and cardiac arrest >7.5 mmol/L

Hypomagnesaemia

Slight increase in QRS complex, T waves flattened, U waves, predisposes to supraventricular tachycardia, Torsade de pointes

  1. aThis can be quite variable and patients with CKD and chronic hyperkalaemia may have no ECG changes with potassiums of 7–7.5 mmol/L

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© 2014 Springer-Verlag London

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Fürstenberg, A., Walsh, S.B., Laing, C.M. (2014). Common Electrolyte Disorders. In: Harber, M. (eds) Practical Nephrology. Springer, London. https://doi.org/10.1007/978-1-4471-5547-8_9

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  • DOI: https://doi.org/10.1007/978-1-4471-5547-8_9

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  • Publisher Name: Springer, London

  • Print ISBN: 978-1-4471-5546-1

  • Online ISBN: 978-1-4471-5547-8

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