ICU Vivas · Electrolytes
Data viva — an electrolyte panel and an ECG
A data-interpretation viva in which the candidate is given an electrolyte panel (sodium, potassium, calcium, magnesium, renal function) and an ECG, and must integrate the two — recognising the hyperkalaemic ECG and the management it demands.
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CICMFFICMEDIC
Prompt
A biochemistry panel and a 12-lead ECG from a patient presenting with weakness, to be interpreted together.
Stimulus
You are shown the panel and the ECG of a 65-year-old man with chronic kidney disease presenting with weakness:
| Variable | Value | (normal) |
|---|---|---|
| Sodium | 138 mmol/L | (135–145) |
| Potassium | 6.9 mmol/L | (3.5–5.0) |
| Calcium (ionised) | 1.10 mmol/L | (1.15–1.30) |
| Magnesium | 0.70 mmol/L | (0.7–1.0) |
| Creatinine | 310 micromol/L | (60–110) |
| pH | 7.30 | (7.35–7.45) |
The ECG shows peaked, tented T waves across the precordium and a QRS widened to 120 ms. Interpret the findings together.[1]
References3ShowHide
- [1]Kovesdy CP. Management of hyperkalaemia in chronic kidney disease. Nature Reviews Nephrology, 2014.PMID 25223988
- [2]Bersten AD, Soni N (eds) Oh's Intensive Care Manual. 8th edition, Elsevier, 2018.
- [3]Marino PL The ICU Book. 4th edition, Lippincott Williams & Wilkins, 2014.