Hyperkalemia, cardiac conduction, and the electrocardiogram: A review

Ettinger, Philip O.; Regan, Timothy J.; Oldewurtel, Henry A.

doi:10.1016/0002-8703(74)90473-6

Cited by 182 publications

(101 citation statements)

References 60 publications

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“…Bundle of His studies in the dog have shown that A-V conduction failure does occur at higher K" concentration^,'^,",^^ indicating progressive A-V nodal block.20 It has been shown that the cardiotoxic effects of hyperkalemia can be exacerbated by concurrent hyponatremia and/or hypocalcemia. 12,20,30 This, in conjunction with decreased intracellular K+ concentrations could possibly explain the clinical finding of hyperkalemic atrial standstill in diarrhetic calves at lesser K+ concentration than in experimentally induced hyperkalemic atrial ~t a n d s t i l l .~' -~~,~' Arrhythmia and/or bradycardia in a diarrhetic calf should alert the examiner to the possible presence of hyperkalemia. Assessment of acid-base status, serum electrolyte concentrations, and renal function can assist the diagnosis and management of the hyperkalemic patient.…”

Section: Journal Of Veterinarymentioning

confidence: 99%

Hyperkalemic Atrial Standstill in Neonatal Calf Diarrhea

Weldon

Moı̈se

Rebhun

1992

Veterinary Internal Medicne

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Hyperkalemia has been associated with cardiac abnormalities and muscular disorders. Hyperkalemia is a common problem associated with the acid-base and electrolyte disturbances that occur in neonatal calves having acute diarrhea. Occasional calves with acute neonatal diarrhea, metabolic acidosis, and hyperkalemia have cardiac rate or rhythm abnormalities. Bradycardia observed in three such calves was found to represent atrial standstill and was attributed to hyperkalemia. (Journal of Veterinary Internal Medicine 1992; 6:294-297)INFECTIOUS DIARRHEA is a frequent and often fatal disease affecting calves in the first weeks of Numerous causative organisms have been r e p~r t e d ,~ including enterotoxigenic Escherichia coli, rotavirus, coronavirus, Salmonella spp, Clostridia spp, and crypto~poridia.~-~ The profuse diarrhea associated with infection by these organisms can lead to significant losses in bicarbonate, electrolytes, and water and severe lifethreatening metabolic disturbances. lo Concomitant metabolic acidosis can cause significant transcellular electrolyte shifts whereby potassium ions leave the cell to enter the extracellular fluid in exchange for hydrogen ions."-14 Dehydration can further contribute to this hyperkalemic state by decreasing renal blood flow, thereby decreasing potassiumIn response to hypovolemia, sodium reabsorption in the proximal tubule results in decreased delivery of sodium and water to the distal tubular sodium-dependent potassium secretory site, which results in potassium accumulation.I6 As the serum potassium increases (>5.5 mEq/ L), aberrations in cardiac excitability occur and are manifested as progressive atrial standstill and, if left untreated, ultimately as ventricular fibrillation or asysIn this article, we describe three calves in which diarrhea was believed to contribute to hyperkalemia along with the associated electrocardiographic finding of atrial standstill. cine as a representative of a recent farm outbreak of neonatal calf diarrhea during which seven calves had died. The calf had received colostrum, an E. coli bacterin, and a selenium injection at birth. Before amval, this calf had been treated with scour boluses, oral electrolytes, and penicillin. Calf 1At initial examination, the calf was recumbent, dehydrated (-8%), hypothermic (T = 97.OoF/36. 1 1 "C), and had profuse watery diarrhea of 12 hours duration. Auscultation revealed bradycardia (heart rate = 88 beats/ min), poor pulse quality, and occasional pulse deficits. Electrocardiographic analysis showed an irregular rhythm, no P-waves, and inconsistent supraventricular premature complexes with aberrant ventricular conduction ( Figure 1A). A serum biochemical profile indicated marked hyperkalemia (K = 9.6 mEq/L), azotemia (BUN = 105.0 mg/dL), increased creatinine concentration (6.1 mg/dL), and an increased anion gap (34.0 mEq/L).An intravenous catheter was placed in the jugular vein and therapy with 5% dextrose and 150 mEq NaHC03/L was instituted. Electrocardiographic tracings were done every 15 minutes until a ...

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Section: Journal Of Veterinarymentioning

confidence: 99%

Hyperkalemic Atrial Standstill in Neonatal Calf Diarrhea

Weldon

Moı̈se

Rebhun

1992

Veterinary Internal Medicne

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“…Fowkes-Godek et al 12 ), when American football players supplemented their meals with PJ. Hyperkalemia is a concern because it is associated with cardiac abnormalities 15 and may contribute to the onset of fatigue. 16 Another possible concern is that ingesting PJ may increase [Na þ ] p and plasma osmolality (OSM p ), thereby rapidly expanding plasma volume, decreasing thirst, and impairing rehydration.…”

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confidence: 99%

Plasma and Electrolyte Changes in Exercising Humans After Ingestion of Multiple Boluses of Pickle Juice

McKenney

Miller

Deal

et al. 2015

Journal of Athletic Training

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Context: Twenty-five percent of athletic trainers administer pickle juice (PJ) to treat cramping. Anecdotally, some clinicians provide multiple boluses of PJ during exercise but warn that repeated ingestion of PJ may cause hyperkalemia. To our knowledge, no researchers have examined the effect of ingesting multiple boluses of PJ on the same day or the effect of ingestion during exercise.Objective: To determine the short-term effects of ingesting a single bolus or multiple boluses of PJ on plasma variables and to characterize changes in plasma variables when individuals ingest PJ and resume exercise.Design: Crossover study. Setting: Laboratory.Patients or Other Participants: Nine euhydrated men (age ¼ 23 6 4 years, height ¼ 180.9 6 5.8 cm, mass ¼ 80.7 6 13.8 kg, urine specific gravity ¼ 1.009 6 0.005).Intervention(s): On 3 days, participants rested for 30 minutes, and then a blood sample was collected. Participants ingested 0 or 1 bolus (1 mLÁkg À1 body weight) of PJ, donned sweat suits, biked vigorously for 30 minutes (approximate temperature ¼ 378C, relative humidity ¼ 18%), and had a blood sample collected. They either rested for 60 seconds (0-and 1-bolus conditions) or ingested a second 1 mLÁkg À1 body weight bolus of PJ (2-bolus condition). They resumed exercise for another 35 minutes. A third blood sample was collected, and they exited the environmental chamber and rested for 60 minutes (approximate temperature ¼ 218C, relative humidity ¼ 18%). Blood samples were collected at 30 and 60 minutes postexercise.Main Outcome Measure(s): Plasma sodium concentration, plasma potassium concentration, plasma osmolality, and changes in plasma volume.Results: The number of PJ boluses ingested did not affect plasma sodium concentration, plasma potassium concentration, plasma osmolality, or changes in plasma volume over time. The plasma sodium concentration, plasma potassium concentration, and plasma osmolality did not exceed 144.6 mEqÁL À1 (144.6 mmolÁL À1 ), 4.98 mEqÁL À1 (4.98 mmolÁL À1 ), and 289.5 mOsmÁkg À1 H 2 O, respectively, in any condition at any time. Conclusions: Ingesting up to 2 boluses of PJ and resuming exercise caused negligible changes in blood variables. Ingesting up to 2 boluses of PJ did not increase plasma sodium concentration or cause hyperkalemia.

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“…This is a concern because hyperkalemia is associated with cardiac arrhythmias 33 . Therefore, if clinicians provide 80 mL of PJ postexercise, they must stress to athletes to drink copious volumes of fluid and supplement their meals with Na þ and K þ .…”

Section: Resultsmentioning

confidence: 99%

Electrolyte and Plasma Responses After Pickle Juice, Mustard, and Deionized Water Ingestion in Dehydrated Humans

Miller

2014

Journal of Athletic Training

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Context: Some athletes ingest pickle juice (PJ) or mustard to treat exercise-associated muscle cramps (EAMCs). Clinicians warn against this because they are concerned it will exacerbate exercise-induced hypertonicity or cause hyperkalemia. Few researchers have examined plasma responses after PJ or mustard ingestion in dehydrated, exercised individuals. Objective: To determine if ingesting PJ, mustard, or deionized water (DIW) while hypohydrated affects plasma sodium (Na+) concentration ([Na+]p), plasma potassium (K+) concentration ([K+]p), plasma osmolality (OSMp), or percentage changes in plasma volume or Na+ content. Design: Crossover study. Setting: Laboratory. Patients or Other Participants: A total of 9 physically active, nonacclimated individuals (age = 25 ± 2 years, height = 175.5 ± 9.0 cm, mass = 78.6 ± 13.8 kg). Intervention(s): Participants exercised vigorously for 2 hours (temperature = 37°C ± 1°C, relative humidity = 24% ± 4%). After a 30-minute rest, a baseline blood sample was collected, and they ingested 1 mL/kg body mass of PJ or DIW. For the mustard trial, participants ingested a mass of mustard containing a similar amount of Na+ as for the PJ trial. Postingestion blood samples were collected at 5, 15, 30, and 60 minutes. Main Outcome Measure(s): The dependent variables were [Na+]p, [K+]p, OSMp, and percentage change in plasma Na+ content and plasma volume. Results: Participants became 2.9% ± 0.6% hypohydrated and lost 96.8 ± 27.1 mmol (conventional unit = 96.8 ± 27.1 mEq) of Na+, 8.4 ± 2 mmol (conventional unit = 8.4 ± 2 mEq) of K+, and 2.03 ± 0.44 L of fluid due to exercise-induced sweating. They ingested approximately 79 mL of PJ or DIW or 135.24 ± 22.8 g of mustard. Despite ingesting approximately 1.5 g of Na+ in the PJ and mustard trials, no changes occurred within 60 minutes postingestion for [Na+]p, [K+]p, OSMp, or percentage changes in plasma volume or Na+ content (P > .05). Conclusions: Ingesting a small bolus of PJ or large mass of mustard after dehydration did not exacerbate exercise-induced hypertonicity or cause hyperkalemia. Consuming small volumes of PJ or mustard did not fully replenish electrolytes and fluid losses. Additional research on plasma responses pre-ingestion and postingestion to these treatments in individuals experiencing acute EAMCs is needed.

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Hyperkalemia, cardiac conduction, and the electrocardiogram: A review

Cited by 182 publications

References 60 publications

Hyperkalemic Atrial Standstill in Neonatal Calf Diarrhea

Hyperkalemic Atrial Standstill in Neonatal Calf Diarrhea

Plasma and Electrolyte Changes in Exercising Humans After Ingestion of Multiple Boluses of Pickle Juice

Electrolyte and Plasma Responses After Pickle Juice, Mustard, and Deionized Water Ingestion in Dehydrated Humans

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