A No Alarm on ECG: A Case of Severe Asymptomatic Hyperkalemia with No Significant ECG Changes
DOI:
https://doi.org/10.53778/pjkd94323Abstract
Hyperkalemia usually produces characteristic ECG changes due to its effects on myocardial membrane potential. When these accompany high serum potassium levels, they indicate a medical emergency. However, ECG findings do not always correlate with biochemical severity—sometimes even profound hyperkalemia presents with a normal ECG. We present a case of a 47-year-old woman with chronic kidney disease who exhibited a serum potassium level of over 8 mmol/L yet remained asymptomatic with a normal ECG. This case highlights the diagnostic limitations of ECG in hyperkalemia and emphasizes that management should be guided by biochemical results and clinical context rather than ECG appearance alone.
References
References
Montague BT, Ouellette JR, Buller GK. Retrospective review of the frequency of ECG changes in hyperkalemia. Clin J Am Soc Nephrol. 2008;3(2):324–30.
Khattak HK, Khalid S, Manzoor K, Stein PK. Recurrent life-threatening hyperkalemia without typical electrocardiographic changes. J Electrocardiol. 2014;47(1):109–12.
Quintero JA, Khan A, Ramos G, Lozano W, Pinzon J, Villacreses R, et al. Emergency department management and outcomes of acute hyperkalemia: a retrospective study. BMC Emerg Med. 2023;23(1):77.
Raffee L, Al-Ahmad M, AlAli M, AlSamkari R, Alhowary A, Alshami A, et al. Clinical and electrocardiogram presentations of patients with high potassium levels in the emergency department: a prospective study. Int J Emerg Med. 2022;15(1):15.
Weisberg LS. Management of severe hyperkalemia. Crit Care Med. 2008;36(12):3246–51.
Jehangir W, Qureshi R, Ghani AR, Tizazu A, Bandyopadhyay D, Kim S, et al. Recognition and treatment of potentially fatal hyperkalemia in the emergency department. J Med Cases. 2015;6(5):207–10.
Weiss JN, Qu Z, Shivkumar K. Electrophysiology of hypokalemia and hyperkalemia. Circ Arrhythm Electrophysiol. 2017;10(3):e004667.
Mahmoud A, Saad M, Alhaj M, Kumar V, Nambi S. Sliding with the sines: fatal hyperkalemia – a case report. World J Cardiol. 2021;13(7):230–5.
Haykal T, et al. Severe hyperkalemia with minimal ECG changes: a case report. Res Gate. 2020.
Wrenn K, Slovis CM, Slovis BS. The ability of physicians to predict hyperkalemia from the ECG. Ann Emerg Med. 1991;20(11):1229–32.
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Copyright (c) 2026 Namrah Namrah Nasir, Dr. Zahid Nabi, Dr. humayun Rashid
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