A 14-year-old boy was brought in a collapsed state with history of 2 episodes of vomiting and had feeble pulse and cold, clammy limbs. ECG is given (Figure). What is the diagnosis?

Ans: (b) HyperkalemiaRef: Nelson Textbook of Pediatrics, 20th edition, Page 360ECG shows classical 'sine wave pattern' associated with hyperkalemia.Electrolyte abnormalityECG findingsHypokalemia (< 2.5 meq/L)Prolonged PR IntervalReduction in T wave amplitude / flattening / inversion ST depression Appearance of U waveHyperkalemia Mild (5.5 to 6.6 meq/L)Peaked T waves Prolonged PR segmentModerate (6.5 to 8 meq/L)Loss of P wave Prolonged QRS complex ST segment elevation Ectopic beast and escape rhythmSevere (> 8.0 meq/L)Progressive widening of QRS complex Sine wave Ventricular fibrillation AsystoleHypocalcemiaProlonged QTc segment (secondary to lengthening of ST segment)HypomagnesemiaST segment depression Tall, peaked T wavesFlat T waves or depression in the precordiumU wavesLoss of voltagePR prolongationWidened QRS complex