Dialysis patients and patients with end-stage renal disease are at risk for hyperkalaemia because renal potassium excretion is reduced or completely absent. Elevated potassium concentration leads to reduced myocardial conduction, and can cause acute death because of arrhythmia.A 67-year-old haemodialysis patient presented at the emergency room after a sudden collapse and paralysis of his legs. Electrocardiograms showed typical changes compatible with severe hyperkalaemia: peaking of the T wave, prolongation of the PR interval, loss of the P-wave amplitude and widening of the QRS complex (figure 1). Laboratory analysis revealed severe hyperkalaemia. (K = 9.3 mmol/1; reference levels are 3.5-4.7 mmol/1). The patient was treated with calcium, insulin, glucose and sodium polystyrene sulphonate. Acute dialysis was arranged. Soon after treatment was initiated, the symptoms resolved and the electrocardiogram normalised.
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