Evaluate this electrocardiogram (ECG) strip and note the effect ...

[Kikoku]

Evaluate this electrocardiogram (ECG) strip and note the effect of any electrolyte imbalances.
 
  Attached the picture below.

Question 2

As soon as you get a chance, you review C.W.'s admission laboratory results.
 
  Laboratory Results
  Sodium 138 mEq/L
  Potassium 6.9 mEq/L
  BUN 90 mg/dL
  Creatinine 2.1 mg/dL
  WBC 16,000/mm3
  Hgb 8.4 g/dL
  Hct 25
  PT 23.4 seconds
  INR 4.8
 
  After examination of the lab results, are there any concerns with C.W.'s electrolyte levels?
  Explain your answer.
 
  In view of the previous laboratory results, what diagnostic test will be performed and why?

[mcomstock09]

Answer to Question 1

The P waves begin to flatten and become wider as serum potassium increases; the PR interval may
be prolonged. The QRS complex begins to widen with potassium levels of 6.0 to 6.5 mEq/L. Also,
ST segments disappear. The T waves become narrow, tall, and peaked, sometimes described as
tentlike. These T waves reach a height that is about 50 of the height of the QRS complex.

Answer to Question 2

C.W.'s potassium level reflects hyperkalemia (above 5 mEq/L), which, in the presence of digoxin, may
lead to serious ventricular dysrhythmias. Keep in mind that hyperkalemia may be present in later
stages of hypovolemia and that the fluid resuscitation will dilute the potassium.

An ECG should be obtained because the patient is on digoxin and has elevated potassium.