Case 141: A 38-Year-Old Man with Severe Hepatosplenomegaly
History
Diagnosis
ECG 2
History
This 38-year-old man was admitted to hospital because of acute onset of right upper quadrant pain, fever, and drenching sweats. He was mildly jaundiced, with massive hepatomegaly and splenomegaly. His liver biopsy showed a high grade B-cell lymphoma replacing his liver parenchyma, with marked cell necrosis. The following ECG was recorded two days after admission. Note that all the leads are recorded at half standardization:
Diagnosis
- Hyperkalemia
- Absent P waves
The patients serum potassium was measured at 10.0 mmol/L. Note the very wide QRS (QRS duration 228 msec). Potassium levels >8.0 mmol/L cause intraventricular conduction abnormalities, with bizarre wide QRS complexes. Also note that the width of the T wave is close to that of the QRS; in intraventricular conduction abnormalities due to other causes or in a ventricular ectopic rhythm, the T wave is usually much wider than the QRS complex. When you see a wide QRS rhythm with T waves that are not significantly wider than the QRS, strongly consider the possibility of life-threatening hyperkalemia!
ECG 2
The patient was identified to have tumor lysis syndrome, with severe cell necrosis causing marked hyperkalemia. He was treated with hemodialysis, and the following normalized ECG tracing was recorded following dialysis, when his serum potassium was 5.3 mmol/L:
ECG ID: E247