#EPeeps #FellowsFirst The cardiac ICU calls that they are preparing to cardiovert this wide-complex tachycardia. Do you agree? What may be going on?
#EPeeps Many suggested sodium channel blockade or hyperkalemia

This was BOTH! Severe transient hyperkalemia superimposed on high-dose flecainide

Very complex infant on multiple AADs including high-dose propranolol for intractable EAT

Do you know why the propranolol matters? 👇
See separate thread on hyperkalemia and beta blockers for the conclusion

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More from @jeffrey_vinocur

Oct 10
#EPeeps Brief 🧵 on beta blocker hyperkalemia which is unfamiliar to many

The mechanism is the opposite of why we use albuterol to treat hyperkalemia - beta receptor modulation of Na K ATPase, the sodium potassium exchange channel [1/]

See great diagram from @paulpengmdphd Image
Beta blockers rarely cause hyperkalemia in isolation, but can contribute in at-risk patients.

The patient who prompted this discussion (see link) had complex multi-system illness. Ectopy was exacerbated by diuretic-induced hypoK so had MRA + scheduled enteral KCl [2/]
One day, because of hypoK on labs, he received IV KCl replacement almost concurrent with scheduled enteral KCl… probably would not have been a big deal, except for propranolol impairing ability to transport extracellular K intracellular [3/]
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