P-on-U Phenomenon in Hypokalæmia
Report:
Sinus rhythm
Non-specific ST/T changes
Prominent U waves consistent with hypokalæmia
Comment:
The patient was in fact hypokalæmic at 2.9 mEq/L - a frequent finding in sick alcoholics, especially after prolonged vomiting with attendant alkalosis. The ECG normalised with potassium replacement ( Fig 202a below).
T waves are flat, with prominent U waves; P waves fall on the descending limb of the U wave. The P-on-U pun is of course Schamrothâs145.
202a.
203. Ventilated 26 year old man with pulmonary Ådema of the right lung and hypoplasia of the left pulmonary artery
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