Lidocaine-induced conduction disturbance in patients with systemic hyperkalemia

We report 2 cases in which lidocaine, given for wide-complex tachycardia in the presence of hyperkalemia, precipitated profound conduction disturbance and asystole. The electrophysiologic effects of hyperkalemia and its interaction with lidocaine are reviewed. In patients with known hyperkalemia and wide-complex tachycardia, treatment should be directed at hyperkalemia, rather than following treatment algorithms for wide-complex tachycardia. [McLean SA, Paul ID, Spector PS. Lidocaine-induced conduction disturbance in patients with systemic hyperkalemia. Ann Emerg Med. December 2000;36:615-618.]