A 1 week-old male is diagnosed with ARF in the setting of newly diagnosed
posterior urethral valves. His initial serum potassium is 6.3 mMol/L. Which of
the following EKG findings would indicate a possible need for renal replacement
therapy?
a) Prolonged QTc with intermittent Q-waves
b) Prolonged PR interval and peaked T waves
c) Mobitz type 1 (Wenckebach) second degree AV block
d) Right ventricular hypertrophy with p-pulmonale
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Answer
Answer b. Hyperkalemia may be medically managed in the renal failure patient;
however, the presence of EKG findings is very worrisome and warrants
aggressive therapy with possible initiation of renal replacement therapy. The
first signs of electrocardiographic defects due to hyperkalemia are large
(“peaked”) t-waves and prolongation of the PR interval.
Notes
- This question originally printed in the Pediatric Anesthesiology Review Topics kindle book series, and appears courtesy of Naerthwyn Press, LLC.
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