Document Detail

Hyperkalemia induced failure of pacemaker capture and sensing.
MedLine Citation:
PMID:  18617317     Owner:  NLM     Status:  MEDLINE    
Hyperkalemia may cause cardiac pacemaker (PMK) malfunctioning due to a reduction of the electronegativity of the resting myocardial potential. Both sensing and capture mechanisms could be temporarily affected, with possible life-threatening effects. Calcium chloride may counteract almost immediately such a dangerous effect of hyperkalemia, restoring the normal pacemaker function. We describe the case of a 75-year-old woman, observed in the Emergency Department for extreme weakness, very large QRS complexes, and a pacemaker type II exit block, associated with sensing failure and "spike-on-T" phenomenon. She was managed with immediate i.v. calcium chloride, followed by insulin/glucose and sodium bicarbonate infusions; the ECG recordings show an almost immediate correction of the PMK malfunctioning and serial improvement of the intraventricular conduction. This case supports the feasibility and effectiveness of i.v. calcium administration, as expected on the basis of electrophysiological ionized calcium effect on the threshold potential.
Fernando Schiraldi; Giovanna Guiotto; Fiorella Paladino
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Publication Detail:
Type:  Case Reports; Journal Article     Date:  2008-07-09
Journal Detail:
Title:  Resuscitation     Volume:  79     ISSN:  0300-9572     ISO Abbreviation:  Resuscitation     Publication Date:  2008 Oct 
Date Detail:
Created Date:  2008-09-22     Completed Date:  2009-01-27     Revised Date:  2009-08-25    
Medline Journal Info:
Nlm Unique ID:  0332173     Medline TA:  Resuscitation     Country:  Ireland    
Other Details:
Languages:  eng     Pagination:  161-4     Citation Subset:  IM    
San Paolo Hospital Naples, Italy.
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MeSH Terms
Calcium / administration & dosage
Equipment Failure
Hyperkalemia / complications*
Pacemaker, Artificial / adverse effects*
Reg. No./Substance:

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