Rapid Correction of Hypokalemia in a Patient with an Implantable Cardioverter-Defibrillator and Recurrent Ventricular Tachycardia

Abstract We present the case of a 74-year-old man with non-ischemic dilatated cardiomyopathy and an implantable cardioverter-defibrillator presenting with a serum potassium of 2.6 mmol/L, recurrent unstable ventricular tachycardia, and multiple defibrillations. Administration of a rapid bolus of 20...

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Bibliographic Details
Published in:The Journal of emergency medicine 2010-04, Vol.38 (3), p.308-316
Main Authors: Philips, David A., MD, Bauch, Terry D., MD
Format: Article
Language:English
Subjects:
Action Potentials - physiology
Aged
cardiomyopathy
Cardiomyopathy, Dilated - therapy
Defibrillators, Implantable
Dose-Response Relationship, Drug
Electrocardiography
Electrolytes - administration & dosage
Emergency
Humans
hypokalemia
Hypokalemia - complications
Hypokalemia - drug therapy
Hypokalemia - physiopathology
implantable cardioverter-defibrillator (ICD)
Infusions, Intravenous
Male
potassium
Potassium Chloride - administration & dosage
Tachycardia, Ventricular - complications
Tachycardia, Ventricular - drug therapy
ventricular tachycardia (VT)
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Summary:Abstract We present the case of a 74-year-old man with non-ischemic dilatated cardiomyopathy and an implantable cardioverter-defibrillator presenting with a serum potassium of 2.6 mmol/L, recurrent unstable ventricular tachycardia, and multiple defibrillations. Administration of a rapid bolus of 20 mEq KCL solution via central venous access, followed by an additional total of 80 mEq (orally and intravenously [i.v.]) over the next 2 h, resulted in immediate resolution of his recurrent unstable dysrhythmia without toxic side effects. Guidelines for rapid correction of hypokalemia quote a maximum safe administration of 20 mEq i.v./h. In addition to discussing the clinical relevance and physiologic interactions of the variables leading to this patient's presentation, we discuss the successful termination of his sustained recurrent ventricular dysrhythmia by rapid potassium repletion above currently recommended rates. The patient we present is representative of a growing population, given medical and technological advances over the years. Potassium boluses may be reasonable in such circumstances, particularly in patients with ICDs.
ISSN:0736-4679
2352-5029
DOI:10.1016/j.jemermed.2007.06.019