Electrolyte Abnormalities and Their Impact On ECG- Confirmed Arrhythmias Among Adult Patients in Emergency Department

Abstract

Background: Electrolyte disturbances are prevalent in patients of the emergency department and are a major cause of cardiac electrical instability. Potassium, sodium, calcium, and magnesium disruptions may cause typical ECG abnormalities, and lead to life-threatening arrhythmia. But there is limited data on their prevalence and ECG associations in tertiary-care hospitals in Peshawar.

Objective: To determine the frequency of major electrolyte abnormalities and evaluate their association with ECG-confirmed arrhythmias in adult emergency department patients

 Methods: The study was a descriptive cross-sectional study of 385 adult patients who presented ECG-confirmed arrhythmias. Serum electrolytes were used to measure levels within one hour of presentation and ECG findings were recorded. Chi-square and Fisher exact tests were used to analyze associations.

Results: The most common electrolyte abnormalities were potassium (78.4%), sodium (32.7%), magnesium (31.9%), and calcium (15.8%). The most common arrhythmia was ventricular tachycardia (43.4%), atrial fibrillation (23.1), ventricular fibrillation (13), and supraventricular tachycardia (10.9). Widened QRS (48.6%), prolonged QT (34.5%), peaked T waves (33.2%), and prominent U waves (21.6%), were common ECG findings. There were significant correlations that existed between supraventricular tachycardia and potassium (p < 0.001), sodium (p = 0.001), and calcium (p < 0.001) abnormalities. There was a close relationship between potassium, calcium and magnesium abnormalities and VF (p = 0.001). Sodium (p < 0.001), magnesium (p = 0.002), and potassium (p = 0.016) disturbances were associated with complete heart block. There was no significant relationship with atrial fibrillation or ventricular tachycardia. ECGs have been associated with definite electrolyte abnormalities.

Conclusion: Electrolyte imbalances are very common among emergency patients with arrhythmia and have a significant association with various tachyarrhythmia and conduction abnormalities. Timely detection and early correction with the use of ECG could help decrease the risk of serious cardiac events.