• Jennifer L Martindale, Andrew Aherne, and Richard Sinert.
• Emergency Department, State University of New York Downstate, Kings County Hospital, Brooklyn, New York.
• J Emerg Med. 2014 Sep 1;47(3):e73-6.

BackgroundTo many physicians, hyperkalemia is the first diagnosis ascribed to any patient with end-stage renal disease and abnormal electrocardiographic morphologies or dysrhythmias.Case ReportA 52-year-old man with end-stage renal disease presented in cardiac arrest. The patient was initially presumed to have hyperkalemia, based on the appearance of wide QRS complexes on the monitor. The diagnosis of hyperkalemia was incorrect; the patient was severely hypokalemic and suffered recurrent episodes of ventricular fibrillation and torsades de pointes.Why Should An Emergency Physician Be Aware Of ThisAn emergency physician's differential diagnosis of sudden cardiac arrest in the patient with end-stage renal disease should not be limited to hyperkalemia and myocardial infarction. Hypokalemia should also be considered. Hypokalemia may be an under-recognized cause of sudden cardiac death in this patient population.Published by Elsevier Inc.

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