Case: 37 years old female was admitted to ICU with hypotension, hyponatremia, hyperkalemia, metabolic acidosis, and hypoglycemia. Hypotensive shock is refractory to fluid resuscitation. You highly suspect an adrenal crisis. You order all required workups. What changes do you expect to see in EKG with adrenal crisis?
Answer: EKG changes in Addison's Disease have been interesting since it was first described in 1951. They are considered a marker of clinical severity.
Three EKG changes need to be monitored during the adrenal crisis.
- peaked T waves
- deep negative T waves
- prolongation of the QT interval
Hyperkalemia in the adrenal crisis is the primary driver for most EKG changes.
#cardiology
#endocrine
References:
1. Perez PE, Sze W, Miller J. ELECTROCARDIOGRAM CHANGES IN ADDISON DISEASE: POTENTIAL CLINICAL MARKER FOR ADRENAL CRISIS. AACE Clin Case Rep. 2019 Aug 28;5(5):e307-e310. doi: 10.4158/ACCR-2019-0239. PMID: 31967059; PMCID: PMC6876962.
2. SOMERVILLE W, LEVINE HD, THORN GW. The electrocardiogram in Addison's disease. Medicine (Baltimore). 1951 Feb;30(1):43-79. doi: 10.1097/00005792-195102000-00003. PMID: 14805851.
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