From the Guidelines
A sine wave pattern on an EKG is a life-threatening sign of severe hyperkalemia, requiring immediate medical attention to prevent cardiac arrest. This pattern is typically seen in patients with potassium levels exceeding 7 mEq/L, which can lead to cardiac arrhythmias and arrest if left untreated 1. The clinical signs associated with severe hyperkalemia include flaccid paralysis, paresthesia, depressed deep tendon reflexes, or shortness of breath, and early electrocardiographic signs include peaked T waves, flattened or absent T waves, prolonged PR interval, widened QRS complex, and deepened S waves.
Key Features of Sine Wave Pattern
- The sine wave pattern occurs due to the widening of QRS complexes that eventually merge with T waves, creating a smooth, undulating pattern resembling a sine wave
- This pattern often precedes ventricular fibrillation and cardiac arrest, making rapid recognition and treatment essential for patient survival
- Severe hyperkalemia can be caused by renal failure, and its clinical signs and electrocardiographic changes can be life-threatening if not addressed promptly
Management of Sine Wave Pattern
- Immediate treatment includes calcium gluconate 10% (10 mL IV over 2-3 minutes) to stabilize cardiac membranes
- Insulin (10 units regular insulin IV with 25g dextrose) can be administered to shift potassium into cells
- Sodium bicarbonate (50 mEq IV) may be given if acidosis is present, and albuterol nebulization (10-20 mg) can help shift potassium intracellularly
- Definitive treatment requires potassium removal through medications like sodium polystyrene sulfonate (Kayexalate), diuretics, or dialysis in severe cases, as stated in the 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care 1.
From the FDA Drug Label
CLINICAL STUDIES Medical literature also refers to the administration of calcium chloride in the treatment of magnesium intoxication due to overdosage of magnesium sulfate, and to combat the deleterious effects of hyperkalemia as measured by electrocardiogram (ECG), pending correction of the increased potassium level in the extracellular fluid.
The FDA drug label does not answer the question.
From the Research
Significance of Sine Wave Pattern on EKG
The sine wave pattern on an Electrocardiogram (EKG) is a significant indicator of severe hyperkalemia, a life-threatening condition that requires immediate medical attention.
- A sine wave pattern is characterized by a widened QRS complex with a sinusoidal pattern, as seen in a case report of a 78-year-old male with end-stage renal disease 2.
- This pattern is indicative of severe hyperkalemia, which can lead to fatal arrhythmias if left untreated 2, 3.
- The EKG is a crucial diagnostic tool in identifying patients with potentially lethal hyperkalemia, and the sine wave pattern is a key indicator of this condition 3.
- The presence of a sine wave pattern on an EKG warrants urgent intervention, including cardiac stabilization with calcium and efforts to shift potassium intracellularly with insulin and beta-agonists 2, 4.
- In some cases, the sine wave pattern may be associated with other EKG abnormalities, such as peaked T waves and left bundle branch block-like patterns 5, 6.
- Treatment of hyperkalemia with calcium gluconate may improve main rhythm disorders on the EKG, but its effectiveness in non-rhythm disorders is limited 4.