A 62-year-old female presented to the emergency department (ED) with fatigue and generalized body weakness for the last three days. Upon arrival, initial ECG showed wide complex
tachycardia with sine waves and a heart rate (HR) ranging between 100-170 bpm. She was otherwise vitally stable. The patient had a past medical history of
hyperaldosteronism,
type 2 diabetes mellitus (DM),
chronic kidney disease (CKD) with microalbuminuria, and
hypertension. She also had a history of
cerebrovascular accident (CVA) and residual left-sided weakness more pronounced in the upper limb. Initial venous blood gas (VBG) analysis showed a
potassium level of more than 10 mmol/L,
chloride 114 mmol/L,
bicarbonate 9 mmol/L,
sodium 135 mmol/L, and pH of 7.1. Treatment for
hyperkalemia was started immediately with
calcium gluconate 1 gm that effectively narrowed her QRS complex and normalized her ECG.
Salbutamol nebulization,
glucose/
insulin infusion, and
calcium polystyrene syrup were given. Later, she was started on 100 mg
sodium bicarbonate infusion, and Foley's
catheter was inserted to follow urine output (UOP) strictly. However, she did not show a decrease in serum
potassium levels. Then the patient underwent
hemodialysis for two hours. Her first
potassium reading after
hemodialysis was 5.2 mmol/L. The purpose of this case report is to emphasize the importance of
hemodialysis in patients with persistent severe life-threatening
hyperkalemia.