INTRODUCTION: The population of pain medicine is commonly old, which implicates patients have complicated medical history. We present a case of syncope in outpatient clinic.
CASE REPORT: A 78-year-old woman with a history of hypertension, type 2 diabetes, and chronic kidney failure had a syncope. On examination, she had marked sinus bradycardia (rate 38 beats per min) on electrocardiogram and hyperkalemia and metabolic acidosis on laboratory findings. Atropine and epinephrine was administered and dopamine was given continuously. It was ineffective. When transcutaneous pacing was done, she was turned to be alert and vital sign also to be stable. She received temporary pacemaker insertion and transferred to the intensive care unit for correction of electrolyte imbalance.
CONCLUSION: Syncope is a common symptom and has various etiology. Hyperkalemia can be associated with electrocardiographic changes which lead a syncopal episode.