Relation of abnormalities in concentration of serum potassium to electrocardiographic disturbances

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      • 1.
        1. Electrocardiograms and blood samples for simultaneous chemical analyses were taken from nineteen patients with severe renal insufficiency. Similar studies were made in five patients with diminished and, subsequently, normal concentrations of serum potassium.
      • 2.
        2. Electrocardiographic findings referable to the toxic effect of potassium were observed in four of the patients with renal insufficiency when the concentration of serum potassium was elevated. These findings were not observed when the concentration of serum potassium was normal.
      • 3.
        3. The range of concentration of serum potassium within which associated electrocardiographic disturbances sometimes occurred was 6.8 to 7.6 mEq./L. These disturbances were present consistently at concentrations greater than 7.8 mEq./L. At a given elevated concentration of serum potassium the appearance of the electrocardiogram varied widely.
      • 4.
        4. The most characteristic changes associated with hyperkaliemia in this series were peaked T waves and increase in the duration of the QRS complex. Low amplitude of the T wave and prolonged electrical systole were the most frequent findings in the group with hypokaliemia.
      • 5.
        5. In three of the five patients elevation of the concentrations of serum potassium to normal values did not ameliorate the electrocardiographic disturbances which presumably resulted from low concentrations.
      • 6.
        6. Implications of the present study for the problem of the use of potassium in treatment have been discussed.
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        • Winkler A.W.
        • Hoff H.E.
        • Smith P.K.
        Electrocardiographic changes and concentration of potassium in serum following intravenous injection of potassium chloride.
        Am. J. Physiol. 1938; 124: 478
        • Hoff H.E.
        • Smith P.K.
        • Winkler A.W.
        The cause of death in experimental anuria.
        J. Clin. Investigation. 1941; 20: 607
        • Finch C.A.
        • Sawyer C.G.
        • Flynn J.M.
        Clinical syndrome of potassium intoxication.
        Am. J. Med. 1946; 1: 337
        • Stewart H.J.
        • Smith J.J.
        • Milhorat A.T.
        Electrocardiographic and serum potassium changes in familial periodic paralysis.
        Am. J. M. Sc. 1940; 199: 789
        • Stoll B.
        • Nisnewitz S.
        Electrocardiographic studies in a case of periodic paralysis.
        Arch. Int. Med. 1941; 67: 755
        • Martin H.E.
        • Wertman M.
        Electrolyte changes and the electrocardiogram in diabetic acidosis.
        Am. Heart J. 1947; 34: 646
        • Brown M.R.
        • Currens J.H.
        • Marchand J.F.
        Muscular paralysis and electrocardiographic abnormalities resulting from potassium loss in chronic nephritis.
        J. A. M. A. 1944; 124: 545
        • Holler J.W.
        Potassium deficiency occurring during treatment of diabetic acidosis.
        J. A. M. A. 1946; 131: 1186
        • Keith N.M.
        • Burchell H.B.
        • Bagenstoss A.H.
        Electrocardiographic changes in uremia associated with a high concentration of serum potassium.
        Am. Heart J. 1944; 27: 817
        • Tarail R.
        Electrocardiographic abnormalities in a case of uremia manifesting hyperpotassemia.
        Am. Heart J. 1948; 35: 665
      1. Tarail, R. and Elkinton, J. R. Potassium deficiency and the role of the kidney in its production. J. Clin. Investigation, (in press).

      2. Elkinton, J. R., Tarail, R. and Peters, J. P. Transfers of potassium in renal insufficiency. (Unpublished.)

        • Govan C.D.
        • Weiseth W.M.
        Potassium intoxication; report of an infant surviving a serum potassium level of 12.27 millimoles per liter.
        J. Pediat. 1946; 28: 550
        • Keith N.M.
        • Burchell H.B.
        Potassium intoxication in uremia.
        in: 2nd ed. Federation Proc.6. 1947: 343
        • Langendorf R.
        • Pirani C.L.
        The heart in uremia.
        Am. Heart J. 1947; 33: 282
        • Katz L.N.
        2nd ed. Lea & Febiger, Philadelphia1946
        • Hoff H.E.
        • Humm D.G.
        • Winkler A.W.
        Concentration of potassium in serum and response to vagal stimulation in the dog.
        Am. J. Physiol. 1944; 142: 627
        • Darrow D.C.
        • Miller H.C.
        The production of cardiac lesions by repeated injections of desoxycorticosterone acetate.
        J. Clin. Investigation. 1942; 21: 601
        • Darrow D.C.
        The retention of electrolyte during recovery from severe dehydration due to diarrhea.
        J. Pediat. 1946; 28: 515
        • Darrow D.C.
        Disturbances in electrolyte metabolism and their management.
        Bull. New York Acad. Med. 1948; 24: 147
      3. Danowski, T. S., Peters, J. H., Rathbun, J. C., Quashnock, J. M. and Greenman, L. Studies in diabetic acidosis and coma, with particular emphasis on the retention of administered potassium. (Unpublished.)

        • Darrow D.C.
        Advances in the treatment of diarrhea in infants.
        Texas Rep. Biol. & Med. 1947; 5: 29
        • Nicholson W.M.
        • Branning W.S.
        Potassium deficiency in diabetic acidosis.
        J. A. M. A. 1947; 134: 1292
        • Danowski T.S.
        • Hald P.M.
        • Peters J.P.
        Sodium, potassium, and phosphates in the cells and serum of blood in diabetic acidosis.
        Am. J. Physiol. 1947; 149: 667