Interesting ECG manifestation of Hyperkalemia:

I was fascinated by a classical ECG manifestation of hyperkalemia which showed a regular rhythm, with a widened QRS complex in a sine-wave configuration, and there were no discernible P waves. The T waves were fused with the widened QRS complexes to form the sine-wave pattern (sinoventricular rhythm), raising suspicion of severe hyperkalemia.

The patient's serum potassium level was 9.3 mmol / liter. His condition stabilized after the administration of calcium chloride, bicarbonate, glucose, and insulin therapy, which was followed by hemodialysis.

More higher elevations in K level can result in QRS widening and loss of P waves, with eventual formation of the sine-wave pattern. The rhythm can terminate into ventricular fibrillation or Tdp, if the cardiac membrane is not stabilized.

Early recognition followed by prompt treatment & serial ECG’s are important aspects of management.