From the Research
Early ECG changes in non-bilious vomiting due to gastric outlet obstruction typically include ST segment depression, as this is a common manifestation of hypokalemia, which is often present in such cases 1. The primary mechanism behind these ECG changes involves the loss of gastric acid and potassium through persistent vomiting, leading to metabolic alkalosis and hypokalemia. Some key points to consider include:
- The severity of ECG changes correlates with the duration and intensity of vomiting episodes
- Patients may develop hypochloremia and hyponatremia in addition to hypokalemia
- Treatment should focus on correcting the underlying obstruction and addressing fluid and electrolyte imbalances, particularly potassium replacement
- Intravenous fluid resuscitation with potassium chloride supplementation is typically required, with careful monitoring of electrolyte levels
- These ECG changes are generally reversible once the electrolyte abnormalities are corrected and the gastric outlet obstruction is resolved 2. Other options like elevated T wave, P wave prominent, and T wave sagging may also be seen in various conditions, but ST segment depression is the most relevant early ECG change in the context of non-bilious vomiting due to gastric outlet obstruction, as supported by the study on electrocardiographic manifestations in severe hypokalemia 1.