Pseudohyperkalemia: To Treat or not to Treat

Abstract

Chronic lymphocytic leukemia (CLL) is characterized by excessive production of abnormal lymphocytes in the bone marrow. It usually presents as hepatosplenomegaly and lymphadenopathy along with constitutional symptoms of fever, tiredness, and weight loss. Pseudohyperkalemia may occur in patients with extreme leukocytosis. High serum and plasma potassium levels have been seen in pseudohyperkalemia. Whole blood potassium determination will usually help lead to a correct diagnosis. It is important to diagnose this condition early so that the patients are not inappropriately treated. We aim to highlight that hyperkalemia in CLL patients should only be treated if the patient is symptomatic or if the patient shows cardiac effects of hyperkalemia on electrocardiogram.

Pseudohyperkalemia Associated With Leukemia

“…It is also thought that there may be leakage of potassium from fragile white blood cells in patients with leukemia, leading to falsely elevated potassium. This is theorized to occur due to a lack of energy to maintain sodium/ potassium adenosine triphosphatase activity for the collected large number of white cells in-vitro, resulting in the release of potassium contributing to false hyperkalemia [ 2 , 5 , 7 - 8 ]. Another proposed mechanism is that the heparin in the collection tube causes damage to the membranes of the brittle malignant cells [ 8 ].…”

A Case of Hyperkalemia Versus Pseudohyperkalemia in Chronic Lymphocytic Leukemia

“…1,3 Pseudohyperkalemia has been associated with hyperleukocytosis, more commonly in CLL in adults, but also acute lymphoblastic leukemia in children. [4][5][6][7][8][9] It is thought that hyperleukocytosis increases cell fragility, making cell lysis more common during specimen collection, particularly with smaller-bore needles, as well as transport and centrifugation. Since leukocytes are more prone to lysis than erythrocytes, laboratory detection may not be apparent if erythrocytes are unaffected.…”

Hyperkalemic Emergency: When You Have Taken a Few Too Many KCl Tablets

“…Albuterol 10-15 mg nebulized is also used to transfer potassium intracellularly, with onset of 60-90 minutes. The combinatiosn of insulin/glucose and nebulized albuterol are likely most effective for lowering potassium emergently [16][17][18].…”