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Old 10-17-2011
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EKG The EKG of this Chronic Renal Failure patient!

A 69-year-old woman is brought by ambulance to the emergency room complaining of severe muscle pains and cramps. She has a history of end-stage renal disease due to long-standing hypertension and diabetes, and is well known to the emergency room staff. Because she is often non-compliant with her medications and dialysis treatment, she requires frequent hospitalizations. A quick review of her records indicates that she has missed her last two hemodialysis appointments, and has a creatinine of 9.4 mg/dL. A stat electrocardiogram is ordered to gauge the severity of her electrolyte abnormality. Chemistries are pending. Which of the following is the first change likely to be seen on the electrocardiogram in this patientís electrolyte abnormality?

A. Diffuse P-wave flattening
B. Prolonged PR interval
C. Prominent U waves
D. Sinusoidal-appearing QRS
E. Tall, peaked T waves
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Old 10-18-2011
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ans E. tall T waves . due to hyperkalemia...
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Old 10-18-2011
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E.

Tall, peaked T waves
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Old 10-18-2011
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The correct answer is E. Noncompliant dialysis patients with muscle cramps are often suffering from hyperkalemia. The EKG findings of hyperkalemia are important to recognize, and occur in stepwise fashion. The first finding is the presence of tall, peaked T waves. As the hyperkalemia worsens, P-wave flattening (choice A) becomes prominent. The PR interval then becomes prolonged (choice B) and the QRS complex begins to widen. This finding presages life-threatening hyperkalemia. In severe cases, the EKG will appear sinusoidal (choice D). Knowing the progression of EKG changes allows you to roughly gauge the urgency of intervention and choose an appropriate treatment.
Prominent U waves (choice C) are present in hypokalemia. Patients with severe renal failure lose the ability to excrete potassium and are unlikely to suffer from hypokalemia.
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Old 10-18-2011
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Please keep on with this Qs
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Quote:
Originally Posted by ag2011n View Post
Please keep on with this Qs
Yeah, Actually it's helping me to... Endocrinology questions will be over in 2 days... Then I will start posting Cardiology questions...
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anxiously ,waiting for cardio questions
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Old 10-18-2011
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E... Ecg changes in uremic pt not compliant to dialysis ... Muscle cramps too is likely to be secondary to hyperkalemia
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EKGs-, Electrolytes-, Nephrology-, Step-2-Questions

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