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akroeze

Peaked T waves immediately post seizure?

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Had someone seize in front of us a week or two ago and immediately after coming out of the seizure she had extremely large T waves, they were about have the size of the R wave and the R wave went almost to the top of the strip so that should give you an idea of how large. Over several minutes they decreased in size back to normal.

Anyone seen this before? What causes it? My guess is that there is a rapid uptake of K+ causing a transient hyperkalemia but I don't know why this would be and I can't find any literature to support this.

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Had someone seize in front of us a week or two ago and immediately after coming out of the seizure she had extremely large T waves, they were about have the size of the R wave and the R wave went almost to the top of the strip so that should give you an idea of how large. Over several minutes they decreased in size back to normal.

Anyone seen this before? What causes it? My guess is that there is a rapid uptake of K+ causing a transient hyperkalemia but I don't know why this would be and I can't find any literature to support this.

You're right that it probably is due to hyperkalemia- although it's probably due to a sudden transient release of potassium from damaged muscle cells into the bloodstream as a result of the seizure, rather the absorption of K+ into cells. The other possibility is that the T wave alterations are a sign of myocardial ischemia brought about by hypoxia and/or catecholamine release during the seizure episode. Without lab tests and a 12-lead there really is no way to be certain, but one of the above situations would be my guess.

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Most often...it's due to hyperkalemia...

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Most likely would be realative hyperkalemia. If you think about a generalized seizure, it causes global tonic/clonic activity, both of which cause skeletal muscle depolarization. Thinking back to A&P, depolarized muscle cells cause a gradient shift in extracellular K+ because of the sodium/potassiu pump. Depolarization causes sodium to transfer into the cell and potassium to transfer out. The Na and K initially switch out much faster than they return.

Cellular degredation and rupture (death) might be a contributing cause but probably to a much lesser extent than the Na/K pump. In the case of the Na/K pump, the hyperkalemia would self correct in a short period of time (which I would assume happened here) and in cellular rupture it would obviously be a much longer duration as the kidneys would have to compensate by excreting the excess K+.

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"akroeze,"

These sites and the info in the pages provided will give you a good idea of the current, studies and evidence..

[web:218336190d]http://www.emedicine.com/neuro/topic658.htm[/web:218336190d]

http://www.aemj.org/cgi/content/abstract/13/2/174

Hope this helps,

ACE844

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-- Calvin

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