April - June 2010, Volume 6, Issue 2

Isik S, Berker D, Aydin Y, Ozuguz U, Tutuncu Y, Simsek Y, Guler S

Severe hyperkalemia without electrocardiographic changes in a patient with Addison disease

Acta Endo (Buc) 2010, 6 (2): 251-255
doi: 10.4183/aeb.2010.251

Objective. Hyperkalemia is one of the most common acute life-threatening metabolic emergencies. Alterations in serum potassium (K+) levels can have dramatic effects on\r\ncardiac cell conduction and may lead to electrocardiographic (ECG) changes. But in some\r\npatients ECG changes do not accompany serum K+ abnormalities. Severe hyperkalemia secondary to Addison Disease (AD) is rare.\r\nCase. A 40-year-old woman with AD was admitted to emergency service with generalized pain. The patient?s serum K+ level was found to be at the highest level that can be detected in our laboratory (>10.0 mmol/L, normal 3.5-4.5 mmol/L) and repeated serum K+ confirmed the previous result. Results of repeated ECGs have revealed a normal sinus rhythm. Our case is particularly interesting because it demonstrates an Addison patient that has an extremely high level of K+ (>10 mmol/L) without any accompanying ECG changes.\r\nConclusion. Our case confirms that diagnostic ECG changes do not always accompany severe hyperkalemia. Therefore, clinicians should be careful that ECG may look\r\nnormal in the presence of severe hyperkalemia.

Keywords: Hyperkalemia, Addison Disease, chronic renal failure,\r\nelectrocardiography

Correspondence: Dilek Berker, MD, Ministry of Health, Ankara Numune Research and Training\r\nHospital, Endocrinology and Metabolism Clinic, 23.Cad Simkent Sitesi No:8/11 Kirkkonaklar,\r\nAnkara, Turkey. Phone: +905056275953, fax: +903123093398 E-mail: dberker6@yahoo.com