Pathology - Hyperkalemia
Pathophysiology The patient had substantially compromised renal function; skipping scheduled dialysis resulted in fluid overload and hyperkalemia. He needs dialysis right away because his body has accumulated fluid and poisons. There may be mild hyperventilation, which is an attempt to make up for the metabolic acidosis brought on by insufficient kidney function. The patient's hyperkalemia, which might result in deadly dysrhythmia, is the reason why the ECG results are very concerning. Moderate hyperkalemia is indicated by elevated (or "peaked") T waves and decreased P wave amplitude in the ECG. More severe electrolyte imbalances can cause the QRS to broaden and the ECG to start looking like a sine wave. Elevated serum potassium levels cause direct effects on the repolarization of the ventricular cell membrane, which leads to problems in conduction. Intravenous calcium is used in this patient's care to stabilize membrane potentials and lower the chance of an arrhythmia. Additional short-term tactics include the intravenous (IV) infusion of bicarbonate, insulin (with glucose), or beta-2 agonist drugs to lower serum potassium levels and cause an intracellular potassium shift. However, in order to adequately manage this patient's severe condition, emergency dialysis is necessary.
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