ECG manifestations of multiple electrolyte imbalance: peaked T wave to P wave ("tee-pee sign").
The surface electrocardiogram (ECG) is a useful instrument in the detection of metabolic disturbances. The accurate characterization of these disturbances, however, may be considerably more difficult when more than one metabolic abnormality is present in the same individual. While "classic" ECG presentations of common electrolyte disturbances are well described, multiple electrolyte disturbances occurring simultaneously may generate ECG abnormalities that are not as readily recognizable. We report a case of hyperkalemia, with concurrent hypocalcemia and hypomagnesemia resulting in (1) peaking of the T wave, (2) a prominent U wave, and (3) prolongation of the descending limb of the T wave such that it overlapped with the next P wave. In this particular ECG from a patient with combined electrolyte imbalance, we have dubbed the unusual appearance of the segment between the peak of the T wave to the next P wave as the "tee-pee" sign.
Arrhythmia Service, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada.
Amer M
AM
Johri
Adrian
A
Baranchuk
Christopher S
CS
Simpson
Hoshiar
H
Abdollah
Damian P
DP
Redfearn
D015746:Abdominal Pain / Q000209:etiology; D002121:Calcium Channel Blockers / Q000008:administration & dosage; D002125:Calcium Gluconate / Q000008:administration & dosage; D004562:Electrocardiography / Q000379:methods*; D005440:Fluid Therapy / Q000379:methods; D006801:Humans; D006947:Hyperkalemia / Q000150:complications / Q000503:physiopathology / Q000628:therapy; D006996:Hypocalcemia / Q000150:complications / Q000503:physiopathology / Q000628:therapy; D007004:Hypoglycemic Agents / Q000008:administration & dosage; D007328:Insulin / Q000008:administration & dosage; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000150:complications / Q000188:drug therapy; D008274:Magnesium / Q000097:blood; D008278:Magnesium Sulfate / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D011137:Polystyrenes / Q000008:administration & dosage; D014839:Vomiting / Q000209:etiology; D014883:Water-Electrolyte Imbalance / Q000150:complications / Q000503:physiopathology* / Q000628:therapy
D002121:Calcium Channel Blockers; D007004:Hypoglycemic Agents; D007328:Insulin; D011137:Polystyrenes; C003321:polystyrene sulfonic acid; D008278:Magnesium Sulfate; D008274:Magnesium; D002125:Calcium Gluconate