Correlation of Iatrogenic Mild Hyperkalaemia and Bradyarrhythmia: A Problem of Polypharmacy in Elderly
A Problem of Polypharmacy in Elderly
Abstract
Mild hyperkalaemia does not typically cause cardiac symptoms. However, for an
elderly patient on atrio-ventricular (AV) nodal blocker, even mild hyperkalaemia may result in disastrous outcome. We report a case of persistent bradyarrythmia caused by iatrogenic hyperkalaemia in a patient who had concomitant use of AV nodal medication. An 81-year-old lady with multiple comorbidities and a long list
of medications presented with symptomatic bradyarrhythmia. She, in fact, had
two AV nodal blockers in her prescription, a beta-blocker and amiodarone. Her potassium level was found to be mildly elevated due to acute renal failure. She remained bradycardic despite initial treatment and was subsequently dependant on intravenous isoproterenol until her renal function improved. This case highlights the different threshold for manifestation of hyperkalaemic symptoms in a growing group of patients: elderly patients with multiple comorbidities and polypharmacy.
Keywords :
bradyarrythmia,
bradycardia,
elderly,
Hyperkalaemia,
polypharmacy,
Abstrak
Hiperkalemia ringan selalunya tidak menyebabkan gejala yang melibatkan jantung. Akan tetapi bagi pesakit tua yang menggunakan ubat penghalang atrio-ventrikular (AV), hiperkalemia ringan sekalipun boleh membawa musibah. . Kami melaporkan satu kes bradiarithmia berpanjangan disebabkan hiperkalemia iatrogenik pada seorang pesakit yang menggunakan ubatan penghalang AV. Seorang wanita berusia 81 tahun yang mengambil pelbagai ubatan kerana beberapa masalah perubatan telah datang dengan gejala bradiarithmia. Malah beliau mempunyai dua jenis ubat preskripsi penghalang AV yang berbeza iaitu penghalang beta dan amiodaron. Tahap potassium beliau agak tinggi sedikit disebabkan kerosakan buah pinggang akut. Gejala bradikardia beliau berterusan dan beliau bergantung kepada ubat isoproterenol sehingga fungsi buah pinggang kembali normal. Kes ini menekankan paras yang berbeza untuk manifestasi gejala hiperkalemia berlaku kepada kumpulan pesakit yang semakin ramai: pesakit tua yang mempunyai pelbagai masalah kesihatan dan polifarmasi.
Kata Kunci :
bradiarithmia,
bradikardia,
Hiperkalemia,
orang tua,
polifarmasi,
Correspondance Address
Tan Toh Leong. Department of Emergency Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Malaysia. Tel: +603-91458224 Fax: +603-91456577 E-mail: sebastianttl@yahoo.co.uk
