title: Arrhythmias and ECG changes in life threatening hyperkalemia in older patients treated by potassium sparing drugs.
abstract: BACKGROUND
  Severe hyperkalemia is a life threatening condition that can cause fatal rhythm disturbance and terminal heart arrest. The most common cause of hyperkalemia in older patients is that of iatrogenic medication-related etiology due to associated polymorbidity, polypharmacy and reduced reserve metabolic capacity. The aim of this paper is to increase awareness in the clinicians of the risk of hyperkalemia in elderly patients treated by potassium sparing drugs.
  
  
  RESULTS
  We present two case reports of hyperkalemia ≥ 9.0 mmol/L induced by potassium sparing medications with cardiac arrhythmias and severe ECG changes including atrial asystole, disturbance of intraventricular conduction and morphological changes such as tenting T waves and deformed wide QRS complexes. The most frequent causes of hyperkalemia in elderly patients are discussed and electrocardiogram changes and arrhythmias in hyperkalemia are analyzed, as well as their treatment and prevention.
  
  
  CONCLUSIONS
  Potassium sparing drug therapy in older persons requires more frequent monitoring especially when drugs or their doses are changed, or during concomitant acute illness.
authors.affiliation: Department of Geriatrics, 1st Faculty of Medicine, Charles University, Prague, Czech Republic.
authors.forename: Marie
authors.initials: M
authors.lastname: Berkova
authors.forename: Zdenek
authors.initials: Z
authors.lastname: Berka
authors.forename: Eva
authors.initials: E
authors.lastname: Topinkova
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000584:Amiloride / Q000009:adverse effects*; D001145:Arrhythmias, Cardiac / Q000209:etiology*; D004232:Diuretics / Q000009:adverse effects*; D016903:Drug Monitoring; D004562:Electrocardiography; D005260:Female; D006801:Humans; D006947:Hyperkalemia / Q000139:chemically induced* / Q000503:physiopathology* / Q000628:therapy; D008297:Male; D011188:Potassium / Q000097:blood
chemical_list: D004232:Diuretics; D000584:Amiloride; D011188:Potassium