Complex metabolic disturbances are an important feature of critical illness, though simpler abnormalities, such as hypokalaemia are present in a significant proportion of patients. Whilst increasing the complexity of management plans, these circumstances also increase the risk of cardiac complications, such as arrhythmia, and furthermore are associated with increased mortality. Arrhythmic risk is promoted by electrolyte, acid base and fluid balance disturbance, increased sympathetic drive and cardiac ischaemia. Moreover, complex pharmacological regimes may exacerbate the situation. On rarer occasions metabolic disarray can impair myocardial excitation-contraction coupling resulting in cardiac failure. Management of the underlying pathology may be all that is required to allow rapid normalisation of the metabolic profile. However, targeted metabolic intervention may be required on occasions to prevent or assist in the correction of cardiac compromise.
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