Adrenergic-mediated exposure of hyperkalemia in the electrocardiogram

We document full exposure of the electrocardiographic hyperkalemia signs brought about by exogenous epinephrine in a patient on long-term β-blockade treatment in whom spironolactone-induced hyperkalemia developed. We propose that the stimulated adrenergic receptor promoted re-expression of two main potassium channels (IKr, IKs) involved in ventricular repolarization, modifying the ECG waveform. The effects of hyperkalemia could be aggravated in the presence of β-adrenergic blockade.