Pseudohyperkalemia: Hyperkalemia Cocktail or Alternative Diagnosis

Introduction. Hyperkalemia is a commonly encountered clinical problem. Pseudohyperkalemia is believed to be an in vitro phenomenon that does not reflect in vivo serum potassium and therefore should not be treated. Here, we present a case who unfortunately underwent unnecessary treatment because of f...

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Bibliographic Details
Published in:Case reports in medicine 2018-01, Vol.2018 (2018), p.1-3
Main Authors: Neupane, Sanjay Prakash, Dangal, Mahesh Mani, Sharma, Pratibha
Format: Article
Language:English
Subjects:
Adenosine triphosphatase
Anemia
Blood
Cancer
Cardiac arrhythmia
Case Report
Case reports
Chemotherapy
Chlorambucil
Chronic lymphocytic leukemia
Diagnosis
Dialysis
Embolisms
Hemodialysis
Hemoglobin
Hyperkalemia
Kidney diseases
Laboratories
Leukemia
Leukocytosis
Lymphatic leukemia
Lymphocytes
Medical diagnosis
Metabolism
Nausea
Nephrology
Patients
Potassium
Sodium
Urinary tract infections
Vomiting
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Summary:Introduction. Hyperkalemia is a commonly encountered clinical problem. Pseudohyperkalemia is believed to be an in vitro phenomenon that does not reflect in vivo serum potassium and therefore should not be treated. Here, we present a case who unfortunately underwent unnecessary treatment because of failure to detect the common lab abnormality of pseudohyperkalemia. Case Presentation. A 91-year-old female with a history of chronic lymphocytic leukemia presented to the emergency with nausea and vomiting 24 hours after her first chemotherapy with chlorambucil. Physical examination was overall unremarkable. She had a leukocytosis of 210 × 103/µL with 96% lymphocytes along with chronic anemia with hemoglobin of 8.1 g/dL. Her initial sodium and potassium levels were normal. During the clinical course, her potassium progressively worsened and failed to improve despite standard medical treatment. Patient ultimately underwent dialysis. Conclusions. Differentiating true hyperkalemia from pseudohyperkalemia is very important in selected group of patients to avoid unnecessary medications, higher level of care, and unnecessary procedure including dialysis. We want to emphasize the importance of simple yet profound knowledge of technique of blood draws and basic metabolic panel processing for every clinician in day-to-day practice.
ISSN:1687-9627
1687-9635
DOI:10.1155/2018/9060892