Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2014, 158(1):084-091 | DOI: 10.5507/bp.2012.087

Arrhythmias and ECG changes in life threatening hyperkalemia in older patients treated by potassium sparing drugs

Marie Berkova^a, Zdenek Berka^b, Eva Topinkova^a

^a Department of Geriatrics, 1^st Faculty of Medicine, Charles University, Prague, Czech Republic

^b Department of Internal Medicine II - Gastroenterology and Hepatology, University Hospital Olomouc

Background: Severe hyperkalemia is a life threatening condition that can cause fatal rhythm disturbance and terminal heart arrest. The most common cause of hyperkalemia in older patients is that of iatrogenic medication-related etiology due to associated polymorbidity, polypharmacy and reduced reserve metabolic capacity. The aim of this paper is to increase awareness in the clinicians of the risk of hyperkalemia in elderly patients treated by potassium sparing drugs.

Methods and Results: We present two case reports of hyperkalemia ≥ 9.0 mmol/L induced by potassium sparing medications with cardiac arrhythmias and severe ECG changes including atrial asystole, disturbance of intraventricular conduction and morphological changes such as tenting T waves and deformed wide QRS complexes. The most frequent causes of hyperkalemia in elderly patients are discussed and electrocardiogram changes and arrhythmias in hyperkalemia are analyzed, as well as their treatment and prevention.

Conclusion: Potassium sparing drug therapy in older persons requires more frequent monitoring especially when drugs or their doses are changed, or during concomitant acute illness.

Keywords: hyperkalemia, electrocardiogram, potassium sparing drugs, elderly patients

Received: February 2, 2012; Prepublished online: October 31, 2012; Published: April 1, 2014  Show citation