We experienced a case of unexpected ECG abnormality with
hyperkalemia. A 65-year-old man was suffering from maxillary sinus
cyst and Caldwell-Luc procedure was scheduled. He had
diabetes mellitus and
hypertension for 15 years, and was taking oral
hypoglycemic agent and hypotensive drug (
angiotensin converting enzyme and
angiotensin receptor blockers : ARB). Abnormal findings were HbA1c 7.7% and
glycosuria over 1,000 mg x dl(-1). ECG and other laboratory tests were within normal limits. The patient was monitored with 3 leads ECG during the operation. At one hour and 33 minutes after the start of operation, we detected sudden ECG changes consisting of wide QRS wave and peaked T wave. We consider
hyperkalemia and checked blood
potassium concentration three times. The results were 5.8, 6.3, 6.2 mmol x l(-1), respectively. We treated the patient with
calcium gluconate injection, saline infusion,
furosemide injection and
glucose-
insulin therapy. The ECG was normalized one hour and 23 minutes after the abnormal ECG finding and the
potassium concentration decreased to 4.8 mmol x min(-1). After the operation, the
potassium concentration and
creatinine clearance were within normal limits.
Hyperkalemia in this case might have been induced by
diabetes mellitus, administration of ACEI and ARB, and
hypovolemia.