ECG changes in dyselecrolytemia paediatrics
Reading Document
Likely you mean ECG changes in pediatric dyselectrolytemia (electrolyte disturbances in children).
Key ECG changes by electrolyte abnormality (children)
| Electrolyte disorder | Typical ECG findings | Dangerous progression |
|---|---|---|
| Hyperkalemia | Tall, narrow, “tented” T waves (precordial leads), shortened QT initially | PR prolongation, P-wave flattening/loss, QRS widening, sine-wave pattern, VT/VF/asystole |
| Hypokalemia | Flat/inverted T waves, ST depression, prominent U waves (best V2 to V4), apparent QT prolongation (actually QU prolongation) | PVCs, SVT, VT, torsades risk (especially with low Mg) |
| Hypercalcemia | Short QT (short ST segment) | Severe cases: bradyarrhythmias, AV block (rare) |
| Hypocalcemia | Prolonged QT (mainly prolonged ST segment) | Torsades/polymorphic VT risk if marked or with other triggers |
| Hypermagnesemia | PR prolongation, QRS widening, bradycardia (usually at high levels) | AV block, hypotension, cardiac arrest in severe toxicity |
| Hypomagnesemia | QT prolongation, nonspecific ST-T changes | Torsades, ventricular ectopy, often with concurrent hypokalemia |
| Sodium disorders | No specific classic ECG signature; severe dysnatremia may cause nonspecific ST-T or conduction changes | Usually neurologic issues predominate, but arrhythmias can occur if severe/associated abnormalities present |
Pediatric-specific points
- Use age-appropriate normal ECG values (heart rate, PR, QRS, QTc vary by age).
- In children, isolated ECG signs can be subtle, so correlate with:
- clinical state (dehydration, renal failure, DKA, diarrhea, sepsis, drug ingestion),
- blood gas and full electrolytes (K, Ca, Mg, Na, phosphate).
- Most urgent ECG-electrolyte emergency is hyperkalemia with QRS widening or brady/ventricular rhythm changes.
- In hypokalemia, arrhythmia risk rises sharply when Mg is also low.
- Always review medication contributors (diuretics, beta-agonists, insulin shifts, ACEi, potassium-sparing drugs, calcium infusions, etc.).
Quick bedside approach
- Confirm rhythm, rate, QRS width, and QTc.
- Look for pattern:
- peaked T + widening QRS -> think hyperK
- U waves + ST depression -> think hypoK
- short QT -> hyperCa
- long QT -> hypoCa or hypoMg (or drugs/congenital)
- Send urgent repeat electrolytes and treat life-threatening abnormalities immediately.
- Repeat ECG after correction.
If you want, I can give you a one-page emergency treatment algorithm linked to each ECG pattern (pediatric doses style).
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