Tolerating Extreme Hyperkalemia in a Non-Compliant Dialysis Patient

Dialysis patients are known to tolerate high potassium due to the chronic hyperkalemia that is inherent in their disease. Despite this, most reports of extremely high potassium (>9 mmol/L) are in the setting of cardiac arrest. We describe the case of a 57-year-old Caucasian male with past medical history significant for end stage renal disease known to be non-adherent to a low potassium diet as well as missed dialysis appointments. Stat potassium off of a basic metabolic panel was 10.2 mmol/L, which was non-hemolyzed and confirmed on repeat testing. A stat EKG was performed which revealed peaked T waves, mildly increased PR interval (200 ms), and mild QRS widening (142 ms). There was no evidence of bradycardia or sinusoidal wave form. The patient received emergent dialysis and his EKG normalized.