Do Hemolyzed Potassium Specimens Need to be Repeated?

Khodorkovsky, Boris; Cambria, Bartholomew; Lesser, Martin; Hahn, Barry

doi:10.1016/j.jemermed.2014.04.019

Cited by 17 publications

(11 citation statements)

References 10 publications

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“…A prospective study in an emergency department in New York showed that in the setting of haemolysis, eGFR >60 mL/min/1.73 m 2 in conjunction with a normal ECG is a reliable predictor of false hyperkalaemia, and may eliminate the need for repeat testing. 16 Based on the results of this study, these factors hold true, and can be brought a step further. As >90% of patients with eGFR >60 mL/min/1.73 m 2 and 97.2% of patients with haemolysed potassium have false hyperkalaemia, in the presence of both haemolysis and CKD stage 2 or better, patients may omit repeat testing as long as they are asymptomatic.…”

Section: Open Accessmentioning

confidence: 64%

Prevalence and factors associated with false hyperkalaemia in Asians in primary care: a cross-sectional study (the Unlysed Hyperkalaemia- the Unseen Burden (UHUB) study)

Boo

Koh

et al. 2020

BMJ Open

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Serum potassium is part of routine laboratory tests done for patients with hypertension or diabetes mellitus in primary care. Those found to have raised potassium (K>5.5 mmol/L) are recalled for repeat potassium in emergency departments or primary care clinics. Repeat potassium are often normal (≤5.5 mmo/L), that is, false hyperkalaemia. Haemolysis is known to cause false hyperkalaemia. We postulated that unlysed false hyperkalamia was prevalent and was associated with factors such as delayed processing time.ObjectiveWe aimed to determine the prevalence of unlysed false hyperkalaemia and the factors associated with false-and-true-hyperkalaemia.SettingOutpatients in a cluster of public primary care clinics (polyclinics) in Singapore.ParticipantsAll patients of any ethnicity aged ≥21 with serum potassium test done.MethodsElectronic health records of index patients with potassium >5.5 mmol/L and its corresponding laboratory processing time in seven local polyclinics were reviewed between August 2015 and August 2017. Haemolysed specimens and patients on sodium polystyrene sulfonate (SPS) suspension were excluded. If repeat potassium level was ≤5.5 mmol/L within 8 days, the case was defined as false hyperkalaemia. The proportion of such patients was computed to determine its prevalence. Linear and logistic regressions were used to identify the associated factors.ResultsThe study population comprised of 3014 index cases, of which 1575 had repeat potassium tests without preceding SPS. 86.4% (1362/1575) of them had potassium ≤5.5 mmol/L. The average processing time among specimens with potassium ≥6.0 mmol/L was 50 min longer, compared with those with potassium <5.1 mmol/L. Risk factors significantly associated with false hyperkalaemia included estimated glomerular filtration rate (eGFR) (60–89 mL/min/1.73 m2, OR=3.25, p<0.001;>90 mL/min/1.73 m2, OR=3.77, p<0.001) and delayed laboratory processing time (beta coefficient 0.001, p<0.001).ConclusionThe prevalence of false hyperkalaemia was 86.4%. Recommendation to repeat potassium tests may target those with eGFR<60ml/min/1.73m2.

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Section: Open Accessmentioning

confidence: 64%

Prevalence and factors associated with false hyperkalaemia in Asians in primary care: a cross-sectional study (the Unlysed Hyperkalaemia- the Unseen Burden (UHUB) study)

Boo

Koh

et al. 2020

BMJ Open

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“…En esta última situación la sensibilidad del ECG desciende 50% aproximadamente. La concomitancia de alteraciones de otros electrolitos (calcio, magnesio) así como la existencia de acidosis metabólica se asocian a mayor (1,2,7,12,18) probabilidad de alteraciones electrocardiográficas . En esta muestra no se pudo demostrar la influencia del calcio y magnesio en las anomalías del ECG.…”

Section: Discussionunclassified

“…La hiperpotasemia se define por el aumento sérico del potasio >5,5 mEq/L. Es un trastorno (1,2) común y constituye la alteración electrolítica más importante por su potencial gravedad . Se detecta en 1-10% de los pacientes hospitalizados según estudios realizados en Estados Unidos, Japón y China (3) .…”

Section: Introductionunclassified

“…No se conocen estudios electrocardiográficos similares en el Servicio de Clínica Médica del Hospital Nacional pues el diagnóstico y tratamiento de la hiperpotasemia se basan exclusivamente en la medición laboratorial, método que puede verse afectado por falsas determinaciones como la (2,5,6) pseudohiperpotasemia .…”

Section: Introductionunclassified

“…marzo 2019; 6 (1):54-62 Manifestaciones electrocardiográficas en pacientes con hiperpotasemia del Servicio de Clínica Médica del Hospital Nacional en 2018(9) cardíaca y arritmias, que pueden progresar a fibrilación ventricular y asístole . Pero también es capaz de producir depresión miocárdica (bradicardia, bloqueo auriculoventricular e interventricular, retardo(4) de conducción y asistolia), que también puede ser fatal .La hiperpotasemia leve a moderada (≥6,5 mEq/L) produce síntomas inespecíficos como(2,12) debilidad generalizada, fatiga, náuseas, vómitos, cólicos intestinales y diarrea . La hiperpotasemia(3,11)…”

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Electrocardiographic manifestations in patients with hyperkalemia of the Medical Clinic Service of the National Hospital in 2018

Peralta

Martínez

Zaracho

et al. 2019

Rev. virtual Soc. Parag. Med. Int

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RESUMENIntroducción: el aumento sérico del potasio >5,5 mEq/L constituye la alteración electrolítica grave pues puede generar alteraciones en la conducción cardiaca y arritmias potencialmente letales. El electrocardiograma es una fuente fiable para determinar la hiperpotasemia. Objetivos: describir los trastornos electrocardiográficos en pacientes internados en el Servicio de Clínica Médica del Hospital Nacional en 2018. Metodología: estudio observacional, transversal, prospectivo de una base de datos secundaria. Se relacionaron los electrocardiogramas y niveles séricos del potasio en varones y mujeres, mayores de edad, con potasio sérico >5,5 mEq/L internados en Servicio de Clínica Médica del Hospital Nacional (Itauguá, Paraguay) en el periodo agosto-diciembre 2018. Resultados: se incluyeron 43 pacientes, 51% varones con edad media 60±13 años y 49% mujeres con edad media 57±14 años. Eran portadores de insuficiencia renal crónica en 91%. El valor medio del potasio sérico fue 6,5±0,8 mEq/L. En 18 sujetos (42%) se detectó alguna alteración electrocardiográfica compatible con hiperpotasemia. Los hallazgos más comunes fueron onda T picuda (21%), índice T/R >0,75 (14%) y bradicardia sinusal (5%). Conclusión: los trastornos electrocardiográficos se detectaron en 42% y el hallazgo más frecuente fue la onda T picuda (21%). ABSTRACT Introduction:The serum potassium increase> 5.5 mEq/L constitutes a serious electrolyte alteration as it can generate problems in cardiac conduction and potentially lethal arrhythmias. The electrocardiogram is a reliable source to determine hyperkalemia. Objectives: To describe electrocardiographic disorders in patients admitted to the Medical ClinicService of the National Hospital in 2018. Methodology: Observational, cross-sectional, prospective study of a secondary database. The electrocardiograms and serum potassium levels were related in adult men and women with serum potassium> 5.5 mEq/L admitted to the Medical Clinic Service of the National Hospital (Itauguá, Paraguay) in the August-December 2018 period. Results: Forty three patients were included, 51% were males with an average age of 60±13 years and 49% women with an average age of 57±14 years. They were carriers of chronic renal failure in 91%. The average value of serum potassium was 6.5±0.8 mEq/L. In 18 (42%) subjects some electrocardiographic alteration compatible with hyperkalemia were detected. The most common findings were peaked T wave (21%), T/R index>0.75 (14%) and sinus bradycardia (5%). Conclusion: Electrocardiographic disorders were detected in 42% and the most frequent finding was the peaked T wave (21%).

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