Electrophysiology of Hypokalemia and Hyperkalemia

Weiss, James N.; Qu, Zhilin; Shivkumar, Kalyanam

doi:10.1161/circep.116.004667

Cited by 251 publications

(262 citation statements)

References 68 publications

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“…Normal blood potassium levels are regulated in quite a narrow range, between 3.5 and 5.0 mM (or mEq/L) [1]. Causes of dehydration, such as gastrointestinal disorders (including diarrhea), renal failure, and excessive perspiration, can disturb potassium homeostasis [1].…”

Section: Introductionmentioning

confidence: 99%

“…Causes of dehydration, such as gastrointestinal disorders (including diarrhea), renal failure, and excessive perspiration, can disturb potassium homeostasis [1]. Both hyperkalemia and hypokalemia can cause muscle dysfunction [1][2][3][4]. The former cause's tachycardia and the latter bradycardia, and both carry a risk of cardiac arrest [1][2][3].…”

Section: Introductionmentioning

confidence: 99%

“…Both hyperkalemia and hypokalemia can cause muscle dysfunction [1][2][3][4]. The former cause's tachycardia and the latter bradycardia, and both carry a risk of cardiac arrest [1][2][3]. Because potassium ions are at their highest concentration in muscles [1,4], changes in potassium levels can lead directly to myopathy.…”

Section: Introductionmentioning

confidence: 99%

“…The former cause's tachycardia and the latter bradycardia, and both carry a risk of cardiac arrest [1][2][3]. Because potassium ions are at their highest concentration in muscles [1,4], changes in potassium levels can lead directly to myopathy. Rarely, hyperkalemia or hypokalemia can manifest as epilepsy [5,6], sensorineural deafness, ataxia, and mental retardation [7].…”

Section: Introductionmentioning

confidence: 99%

“…Intracellular potassium levels are maintained at about 140 mM higher than in the extracellular spaces, where they are present at about 3.5 to 5.0 mM [1]. Concentration gradients of potassium ions are basically formed by a sodium-potassium pump (Na + /K + -ATPase), which pumps potassium ions into the cell and pumps sodium ions out of the cell [1,11].…”

Section: Introductionmentioning

confidence: 99%

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Na+/K+-ATPase activity is largely unrelated to proliferation of P19 embryonic stem cells

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Na+/K+-ATPase activity is largely unrelated to proliferation of P19 embryonic stem cells

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Risk of Cardiac Arrhythmias Among Climbers on Mount Everest

Sherpa,

Sherpa

et al. 2024

JAMA Cardiol

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ImportanceArterial hypoxemia, electrolyte imbalances, and periodic breathing increase the vulnerability to cardiac arrhythmia at altitude.ObjectiveTo explore the incidence of tachyarrhythmias and bradyarrhythmias in healthy individuals at high altitudes.Design, Setting, and ParticipantsThis prospective cohort study involved healthy individuals at altitude (8849 m) on Mount Everest, Nepal. Recruitment occurred from January 25 to May 9, 2023, and data analysis took place from June to July 2023.ExposureAll study participants underwent 12-lead electrocardiogram, transthoracic echocardiography, and exercise stress testing before and ambulatory rhythm recording both before and during the expedition.Main OutcomeThe incidence of a composite of supraventricular (&gt;30 seconds) and ventricular (&gt;3 beats) tachyarrhythmia and bradyarrhythmia (sinoatrial arrest, second- or third-degree atrioventricular block).ResultsOf the 41 individuals recruited, 100% were male, and the mean (SD) age was 33.6 (8.9) years. On baseline investigations, there were no signs of exertional ischemia, wall motion abnormality, or cardiac arrhythmia in any of the participants. Among 34 individuals reaching basecamp at 5300 m, 32 participants climbed to 7900 m or higher, and 14 reached the summit of Mount Everest. A total of 45 primary end point–relevant events were recorded in 13 individuals (38.2%). Forty-three bradyarrhythmic events were documented in 13 individuals (38.2%) and 2 ventricular tachycardias in 2 individuals (5.9%). Nine arrhythmias (20%) in 5 participants occurred when climbers were using supplemental bottled oxygen, whereas 36 events (80%) in 11 participants occurred at lower altitudes when no supplemental bottled oxygen was used. The proportion of individuals with arrhythmia remained stable across levels of increasing altitude, while event rates per 24 hours numerically increased between 5300 m (0.16 per 24 hours) and 7300 m (0.37 per 24 hours) before decreasing again at higher altitudes, where supplemental oxygen was used. None of the study participants reported dizziness or syncope.Conclusion and RelevanceIn this study, more than 1 in 3 healthy individuals experienced cardiac arrhythmia during the climb of Mount Everest, thereby confirming the association between exposure to high altitude and incidence of cardiac arrhythmia. Future studies should explore the potential implications of these rhythm disturbances.

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Electrocardiographic Findings in Ventricular Paced Rhythm With Hyperkalemia

2019

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A man in his 60s with a history of end-stage renal disease status post-renal transplant, atrial fibrillation, and sick sinus syndrome status after dual-chamber pacemaker placement presented to the emergency department complaining of progressively worsening dyspnea and diarrhea of 1 week's duration. He denied any chest pain, palpitations, or syncope. Vital signs on admission were significant for hypoxia with an oxygen requirement of 4 L/min, blood pressure of 130/79 mm Hg, and heart rate of 90 bpm. Physical examination was remarkable for an elevated jugular venous pressure, bilateral pulmonary basilar crackles, and lower extremity pitting edema. Initial laboratory evaluation revealed an elevated potassium level of 9.0 mmol/L and a creatinine level of 2.8 mg/dL. Severe bilateral pulmonary congestion was noted on chest radiography. A 12-lead electrocardiogram (ECG) was obtained at the time of admission (Figure 1). Echocardiography demonstrated a reduced left ventricular ejection fraction of 35% and normal regional wall motion.

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Electrophysiology of Hypokalemia and Hyperkalemia

Cited by 251 publications

References 68 publications

Na+/K+-ATPase activity is largely unrelated to proliferation of P19 embryonic stem cells

Na+/K+-ATPase activity is largely unrelated to proliferation of P19 embryonic stem cells

Risk of Cardiac Arrhythmias Among Climbers on Mount Everest

Electrocardiographic Findings in Ventricular Paced Rhythm With Hyperkalemia

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