A 31-year-old woman presents to the emergency department for feeling weak and fatigue for one week. The patient has a past medical history of end stage renal disease (ESRD) with anuria and systemic lupus erythematous. The reports that she has missed hemodialysis for 10 days due to feeling fatigue. While in the emergency department, the patient has seizure-like activity, and no pulse is palpable. Chest compressions are started and eventually return of spontaneous circulation is achieved.
Which of the following is the most likely cause of this patient’s cardiac arrest?
B) Hyperkalemia
The patient has not had hemodialysis for a prolonged period of time. In patients with ESRD with anuria, electrolyte imbalances occur due to lack of excretion in the urine. Electrolytes that remain elevated are potassium, phosphate, and magnesium. Hyperkalemia can cause ECG changes such as peaked T-waves which, when left untreated, can turn into a sinusoidal pattern because of decreased P wave height, a widened QRS, PR prolongation. This causes an arrhythmia and may lead to cardiac arrest.
Answer choice A: Hypercaclemia, is incorrect. ESRD leads to hypocalcemia, not hypercalcemia.
Answer choice C: Hyperphosphatemia, is incorrect. Longstanding elevated phosphate can cause left ventricular hypertrophy but is less likely to be the main cause of arrhythmia in this patient.
Answer choice D: Hypokalemia, is incorrect. ESRD leads to hyperkalemia, not hypokalemia.
Answer choice E: Hypomagnesemia, is incorrect. ESRD results in hypermagnesemia, not hypomagnesemia.
Key Learning Point
Patients with ESRD are prone to hyperkalemia which can lead to significant ECG changes and cardiac arrhythmia.
