Life-Threatening Ventricular Tachycardia and Transient Brugada-Like Electrocardiographic Abnormalities Caused by Severe Hyperkalemia Due to Urinary Retention in a 55-Year-Old Man.
Aizawa Y, Kato T, Kawamura A • The American journal of case reports • 2026
Severe hyperkalemia secondary to reversible postrenal acute kidney injury caused by urinary retention can simultaneously present with malignant ventricular tachyarrhythmia and transient Brugada-like right precordial electrocardiographic abnormalities that fully resolve with metabolic correction.
Key Findings
Results
Severe hyperkalemia caused by urinary retention-induced postrenal acute kidney injury presented with life-threatening sustained ventricular tachycardia and hemodynamic instability.
The patient was a 55-year-old man with no known cardiovascular disease who presented with palpitations, dyspnea, and diaphoresis.
Electrocardiography demonstrated sustained wide-QRS ventricular tachycardia accompanied by hemodynamic instability.
Recurrent ventricular tachyarrhythmias occurred following initial electrical cardioversion, requiring repeated defibrillation and cardiopulmonary resuscitation.
Intravenous amiodarone and mechanical ventilation were required to manage the arrhythmias.
Bladder catheterization subsequently identified urinary retention as the cause of postrenal acute kidney injury.
Results
Laboratory testing revealed severe hyperkalemia, profound metabolic acidosis, and advanced renal dysfunction as the underlying metabolic disturbances.
Serum potassium was 7.6 mmol/L, confirmed on repeat testing.
Metabolic acidosis was profound with pH 7.059 and bicarbonate (HCO3−) of 13.8 mmol/L.
Advanced renal dysfunction was also identified as part of the clinical picture.
The combination of hyperkalemia and metabolic acidosis was identified as the driver of the electrocardiographic and arrhythmic abnormalities.
Results
Following cardioversion, electrocardiography demonstrated transient Brugada-like right precordial ST-segment abnormalities involving leads V1–V2 in the setting of severe hyperkalemia.
Post-cardioversion ECG showed marked QRS widening, terminal conduction delay, and transient right precordial ST-segment abnormalities in leads V1–V2.
These findings are described as 'transient Brugada-like electrocardiographic abnormalities,' which can cause diagnostic confusion with primary arrhythmic disorders such as Brugada syndrome.
The authors note that such right precordial ST-segment changes in the context of hyperkalemia represent a rare but recognized presentation.
Results
Intravenous calcium gluconate and sodium bicarbonate rapidly improved the electrocardiographic abnormalities caused by severe hyperkalemia and metabolic acidosis.
Administration of intravenous calcium gluconate and sodium bicarbonate was followed by rapid improvement in ECG findings.
This pharmacologic intervention addressed both the membrane-stabilizing effect (calcium gluconate) and the acidosis-driven potassium shift (sodium bicarbonate).
Continuous hemodiafiltration was subsequently performed to further correct hyperkalemia.
Results
Complete resolution of ventricular arrhythmias and electrocardiographic abnormalities was achieved without recurrence following correction of hyperkalemia and metabolic acidosis.
Correction of hyperkalemia together with treatment of metabolic acidosis resulted in 'complete resolution of the ventricular arrhythmias and electrocardiographic abnormalities without recurrence.'
No evidence of structural heart disease or persistent myocardial ischemia was identified during subsequent evaluation.
The reversible postrenal cause (urinary retention) was treated with bladder catheterization, addressing the root etiology.
Conclusions
The authors conclude that severe hyperkalemia from reversible postrenal acute kidney injury can mimic primary arrhythmic disorders, making recognition of this metabolic condition essential to avoid diagnostic error.
The case illustrates that hyperkalemia can simultaneously cause malignant ventricular tachyarrhythmia and transient Brugada-like ECG changes, potentially leading to misdiagnosis.
The authors state that 'recognition of this reversible metabolic condition is essential to avoid diagnostic error and facilitate prompt life-saving treatment.'
Typically, hyperkalemia manifests as progressive conduction abnormalities, bradyarrhythmias, and sine-wave ECG changes; presentation with malignant ventricular tachyarrhythmias is described as rare.
What This Means
This case report describes a 55-year-old man with no prior heart disease who arrived at the hospital with a racing heart, difficulty breathing, and sweating. Tests showed he was experiencing a dangerous rapid heart rhythm (ventricular tachycardia) that required electric shocks, chest compressions, and multiple medications to control. The root cause turned out to be an extremely high potassium level in the blood (7.6 mmol/L, well above the normal range of roughly 3.5–5.0 mmol/L), driven by a blocked urinary tract — his bladder could not empty, which damaged his kidneys and caused potassium to build up to life-threatening levels.
This research suggests that dangerously high potassium can cause not only the slow heart rhythms it is classically associated with, but also fast, deadly rhythms and distinctive ECG patterns on the right side of the heart that look very similar to a genetic heart condition called Brugada syndrome. Doctors might mistake these ECG changes for an inherited disorder rather than a treatable electrolyte imbalance. In this patient, giving intravenous calcium and bicarbonate quickly normalized the ECG, and dialysis plus a urinary catheter fully resolved the problem — with no recurrence and no lasting heart damage.
The practical implication highlighted by this case is that when a patient presents with life-threatening heart rhythm problems alongside unusual ECG patterns, clinicians should promptly check electrolyte levels, particularly potassium, before concluding that the patient has a primary heart condition. Identifying and treating a reversible metabolic cause like hyperkalemia from urinary obstruction can be lifesaving and avoids unnecessary long-term treatment for disorders the patient may not actually have.
Aizawa Y, Kato T, Kawamura A. (2026). Life-Threatening Ventricular Tachycardia and Transient Brugada-Like Electrocardiographic Abnormalities Caused by Severe Hyperkalemia Due to Urinary Retention in a 55-Year-Old Man.. The American journal of case reports. https://doi.org/10.12659/AJCR.954530