Khan Abdullah
Sidra Medicine, Department of Emergency Medicine, Ar-Rayyan, Qatar.
Clin Pract Cases Emerg Med. 2024 Nov;8(4):391-393. doi: 10.5811/cpcem.21173.
A 13-month-old child with past medical history of congenital adrenal insufficiency presented to the emergency department with vomiting and diarrhea. Initially the child was noticed to have bradycardia with normal blood pressure. An electrocardiogram (ECG) showed tall T waves, broad QRS complex, and widened PR interval suggestive of severe hyperkalemia. The initial blood gas showed potassium of 10.7 millimoles per liter. The patient was started on calcium gluconate with immediate resolution of ECG changes. Further management with insulin, dextrose, and sodium polystyrene sulfonate led to normal potassium levels.
Hyperkalemia is a life-threatening condition in children, especially in those with congenital adrenal insufficiency. The ECG showed different changes as the levels of serum potassium levels increased ranging from tall T waves, wide QRS complex, increased PR interval to arrythmias. Immediate treatment with calcium gluconate in such cases has significant cardioprotective effect. It is important to recognize the ECG changes manifested by changes in serum potassium levels. Our patient had classic ECG changes manifested in severe hyperkalemia.
一名13个月大的儿童，有先天性肾上腺皮质功能减退病史，因呕吐和腹泻就诊于急诊科。最初发现该患儿心动过缓但血压正常。心电图（ECG）显示T波高尖、QRS波群增宽和PR间期延长，提示严重高钾血症。初始血气分析显示血钾为10.7毫摩尔/升。患者开始静脉输注葡萄糖酸钙后，心电图改变立即得到缓解。进一步使用胰岛素、葡萄糖和聚苯乙烯磺酸钠治疗后，血钾水平恢复正常。
高钾血症在儿童中是一种危及生命的状况，尤其是在患有先天性肾上腺皮质功能减退的儿童中。随着血清钾水平升高，心电图显示出不同的变化，从T波高尖、QRS波群增宽、PR间期延长到心律失常。在此类情况下立即使用葡萄糖酸钙治疗具有显著的心脏保护作用。认识到血清钾水平变化所表现出的心电图改变很重要。我们的患者在严重高钾血症时出现了典型的心电图改变。
