Emergency Cardiac Pacing in Hyperkalemia

Hyperkalemia can be readily diagnosed when the history is available or characteristic tall peaked T waves are seen on the electrocardiogram. However, emergency treatment may be required in hyperkalemic patients, particularly in the absence of a history or typical electrocardiographic patterns. In the following case report the patient presented in severe congestive heart-failure with a ventricular rate of 20 per minute. Emergency cardiac pacing markedly improved the cardiac failure until more specific therapy was instituted. We believe this to be the first published report of cardiac pacing in hyperkalemia. Patient Summary A 77-year-old diabetic woman was admitted to Montefiore Hospital and Medical Center, Bronx, NY, with a six-hour history of marked congestive heart-failure, and severe epigastric pain. The patient had been hospitalized three months previously in moderate congestive failure and discharged on a regimen of daily digoxin (0.25 mg alternating with 0.50 mg), hydrochlorothiazide (50 mg), and potassium chloride (45