[The electrocardiographic image of acute myocardial infarct in a patient with severe hyperkalemia].

We report herein an insulin dependent diabetic with chronic renal insufficiency on hemodialysis who developed cardiogenic shock, severe metabolic acidosis with kalemia of 9 mmol/L during alimentary intoxication and who presented with an ECG resembling an acute myocardial infarction. Possible pathophysiologic factors in the development of such electrocardiographic patterns have been outlined. It is concluded that in far advanced hyperkalemia an abnormal QRS complex, elevated ST segment and no visible P waves should primarily suggest changes caused by hyperkalemia rather than myocardial infarction.