Profound hyperkalemia and the electrocardiogram. Lack of correlation: a case report

We report a case of severe hyperkalemia as a result of treatment with potassium sparing diuretics, digoxin and angiotensin receptor antagonist valsartan in the presence of renal insufficiency. Inspite of a maximal serum potassium concentration of 10.3 mmol/l, only non-specific ECG changes were found. The patient survived after an uneventful dialysis. Thus severe hyperkalemia may present without typical ECG changes, and values exceeding 10.3 mmol/l may not necessarily be fatal