Diagnosis was hyperkalemia (9.1 mg/dl) secondary to the renal failure. The ECG demonstrates findings consistent with severe hyperkalemia which are widening of the QRS complex, peaking of the T waves and flattening of the P waves. Precordial leads also show right bundle branch block morphology but QRS is more wider than typical right BBB. In cases of severe hyperkalemia, the progressively widened QRS eventually merges with the T wave, forming a sine wave pattern as in this case. Hyperkalemia should be treated as soon as possible. If it is left untreated, asystole with subsequent hemodynamic collapse and death can occur.