Medicina Fluminensis, Vol. 60 No. 4, 2024.
Studija slučaja
https://doi.org/10.21860/medflum2024_321524
Hyperkalemia-induced Activation of an Implantable Cardioverter Defibrillator in Hemodialysis Patient – A Case Report
Ivan Brdar
orcid.org/0000-0002-2467-4013
; KBC Split, Objedinjeni hitni bolnički prijam, Split, Hrvatska
*
Radmila Majhen Ujević
; Zavod za hitnu medicinu Splitsko-dalmatinske županije, Split, Hrvatska
Iva Mustapić Ilić
; KBC Split, Objedinjeni hitni bolnički prijam, Split, Hrvatska
Ivana Ferri Certić
; KBC Split, Objedinjeni hitni bolnički prijam, Split, Hrvatska
Ivanka Đerek
; Zavod za hitnu medicinu Splitsko-dalmatinske županije, Split, Hrvatska
Ingrid Bošan Kilibarda
; HLZ - Hrvatsko društvo za hitnu medicinu, Zagreb, Hrvatska
* Dopisni autor.
Sažetak
Aim: To present a patient undergoing regular hemodialysis who experienced inappropriate shocks from an implanted subcutaneous cardioverter defibrillator (S-ICD) due to hyperkalemia to emphasize the importance of early recognition of this cause of inadequate delivery of electric shocks (ES). Case report: A 65-year-old man called emergency medical services (EMS) for frequent S-ICD activations. This is a patient with terminal renal failure who is undergoing regular hemodialysis treatment and who has
an S-ICD for the secondary prevention of sudden cardiac death. The 12-channel electrocardiogram showed a regular rhythm with bizarre widened QRS complexes and a ventricular frequency of about 50/min. The patient was taken to the emergency department for further treatment. A bedside rapid blood analysis showed highly elevated potassium values (8.6 mmol/L). Appropriate therapy was administered (calcium gluconate, insulin and glucose infusion, salbutamol inhalation), and the patient was admitted to the intensive care unit for urgent hemodialysis. After the electrolyte imbalance was corrected, the ECG was normalized, and there were no further shocks. Examination of the device concluded that device activation occurred due to hyperkalemia with consequent bizarre changes in the QRS complex (QRS 300 ms) that were inadequately discriminated as malignant arrhythmia. Conclusion: During the acute care of patients with S-ICD device activations, it is necessary to consider the possibility of inadequate delivery of ES. It is most often caused by T wave oversensing, and hyperkalemia is a common cause in the group of hemodialysis patients who have implanted cardioverter defibrillators.
Ključne riječi
defibrillators, implantable; hyperkalemia; renal insufficiency, chronic
Hrčak ID:
321524
URI
Datum izdavanja:
1.12.2024.
Posjeta: 217 *