Reversible junctional bigeminy in severe hyperkalemia: electrocardiographic and biochemical correlation: A case report
Year: 2025
Type: article
Study design: Case Report
Abstract: RATIONALE: Severe hyperkalemia is classically associated with peaked T waves, PR prolongation, and QRS widening. However, sustained bigeminal rhythms resulting from junctional escape are exceptionally rare. Detailed correlations between electrocardiographic (ECG) changes and serum potassium levels remain scarce in the literature. PATIENT CONCERNS: A 54-year-old man with end-stage renal disease on maintenance hemodialysis presented with hypotension and bradycardia. DIAGNOSES: ECG revealed a striking bigeminal rhythm characterized by alternating supraventricular and junctional escape complexes, an uncommon arrhythmic manifestation of hyperkalemia. Laboratory testing showed a serum potassium level of 7.5 mmol/L. INTERVENTIONS: The patient underwent emergent hemodialysis for rapid potassium removal and received standard supportive management for hyperkalemia. OUTCOMES: Following hemodialysis, serum potassium normalized to 3.7 mmol/L, and the bigeminal rhythm resolved completely, with restoration of normal sinus rhythm. Serial ECGs demonstrated dynamic and reversible conduction changes in parallel with biochemical correction. LESSONS: This case highlights a rare but reversible presentation of junctional bigeminy secondary to hyperkalemia. Recognition of this distinctive ECG pattern - correlated with paired serum potassium values - can facilitate timely diagnosis and prevent unnecessary interventions.
Source: Medicine
Authors: Amrit Kooner, Robert Luong, Mutsumi Kioka
Institution: University of Nevada, Las Vegas
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $1,950
OpenAlex ID: W4416717847