Chon et al reported a simple decision rule for identifying a patient with symptomatic bradycardia for evidence of severe hyperkalemia. This can help to identify the electrolyte problem before laboratory results are available or unreliable due to specimen hemolysis. The authors are from Seoul National University.
Patient selection: symptomatic bradycardia
Severe hyperkalemia was defined as serum potassium >= 6.0 mmol/L.
Parameters:
(1) maximum precordial T-wave in mm
(2) atrial fibrillation/junctional bradycardia
(3) heart rate in beats per minute
(4) therapy with diltiazem
(5) diabetes mellitus
Parameter
Finding
Points
maximum precordial T-wave
< 8.5 mm
0
>= 8.5 mm
2
atrial fibrillation/junctional bradycardia
no
0
yes
1
heart rate
> 42 beats per minute
0
<= 42 beats per minute
1
therapy with diltiazem
no
0
yes
2
diabetes mellitus
no
0
yes
1
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score: 7
• A score >= 4 has a sensitivity of 0.5 and specificity of 0.92 for hyperkalemia
Performance:
• The c-statistic is 0.86,
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