The post from Veeraish earlier this week reminded me of this patient who demonstrated
an important learning point regarding hypokalemia in hypothermic patients. A 75 year old
woman was found unconscious in her unheated home with overnight temperatures of
-1⁰C. On arrival at the Emergency Department, her core rectal temperature was a
staggering 21⁰C, blood pressure 90/50 and pulse was 28 beats per minute. EKG was
classic, demonstrating slow atrial fibrillation, wide T wave inversion and the characteristic
J waves of hypothermia (see Figure; note that the depth of the J wave inflection
correlates with the degree of hypothermia). Laboratory values included serum potassium
Her renal function was normal. After some initial warming, repeat potassium was 1.6
mmol/L and her heart rate improved. When she had been warmed to 26⁰C, the serum
potassium corrected to 5.1 mmol/L before settling at 3.6 mmol/L (with no potassium
supplementation). Her serum phosphorous level and blood sugars normalized when her
body temperature rose above 30⁰C. She also spontaneously converted to sinus rhythm.
Please Continuing here: http://renalfellow.blogspot.co.uk/2013/07/the-potential-danger-in-treating.html
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