The perennial problem with potassium

Trull, Andrew K.; Jackson, Chris; Walsh, Sarah; Thornton, Andi; Culank, L.S.; McHugh, John

doi:10.1258/000456304322664690

Cited by 10 publications

(6 citation statements)

References 16 publications

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“…The Clinical and Laboratory Standards Institute recommends that serum samples are centrifuged within two hours of venepuncture to ensure the integrity of most analytes. This guidance is supported by several studies showing that potassium is affected by temperature 3–7 and delays in separation of serum from cells. 4,8–10…”

Section: Introductionmentioning

confidence: 73%

Seasonal pseudohyperkalaemia: no longer an issue?

2011

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Section: Introductionmentioning

confidence: 73%

Seasonal pseudohyperkalaemia: no longer an issue?

2011

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“…In vitro, cold reduces Na-K-ATPase activity. Trull et al 22 undertook a study confirming old data suggesting that refrigeration of specimens increased serum potassium values and reported that storage of specimens above 20.3˚C minimized this effect. Using insulated boxes for transport was suggested to avoid erroneous results.…”

Section: Refrigeration Of Samplesmentioning

confidence: 89%

Best practice in primary care pathology: review 9

Smellie

Shaw²,

Bowlees³

et al. 2007

J Clin Pathol

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This ninth best-practice review examines two series of common primary care questions in laboratory medicine: (i) potassium abnormalities and (ii) venous leg ulcer microbiology. The review is presented in question-and-answer format, referenced for each question series. The recommendations represent a précis of guidance found using a standardised literature search of national and international guidance notes, consensus statements, health policy documents and evidence-based medicine reviews, supplemented by MEDLINE EMBASE searches to identify relevant primary research documents. They are not standards but form a guide to be set in the clinical context. Most are consensus rather than evidence-based. They will be updated periodically to take account of new information.

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“…Mean monthly serum potassium values decreased slightly following changed practice, but remained temperature correlated ( r 2 = 0.90). This correlation compares well with another study, 1 which obtained figures equating to an r 2 value of 0.84.…”

Section: Discussionmentioning

confidence: 99%

“…Increasing numbers of queries to our department regarding unexpectedly high serum potassium results (despite satisfactory analytical quality assurance) prompted us to investigate pre-analytical handling of samples for primary care. Pseudohyperkalaemia due to intracellular potassium leakage caused by low ambient temperature and prolonged transit time is well documented 1,2 but five patients had persistent apparent pseudohyperkalaemia despite prompt sample analysis. When re-bled in the pathology department all five had to be asked to refrain from hand gripping and normal potassium results were then obtained.…”

Section: Introductionmentioning

confidence: 99%

Is suboptimal phlebotomy technique impacting on potassium results for primary care?

Bailey

Thurlow

2008

Ann Clin Biochem

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Background: Pre-analytical problems causing pseudohyperkalaemia have been highlighted previously. These include transit time and temperature effects when sample collection points are geographically widely spread. Similarly, inappropriate phlebotomy technique (in particular, requesting patients to fist clench to facilitate venesection) is a documented cause of pseudohyperkalaemia, but its incidence may be impossible to establish. This study illustrates how primary care population serum potassium data altered when local phlebotomy clinics optimized their technique. Methods: The effect of improving phlebotomy was studied by plotting average monthly primary care population serum potassium data and average percentage of samples with hyperkalaemia (5.2 mmol/L or higher) against mean monthly temperature before and after changes in phlebotomy practice. Only samples from primary care were included between 2002 and 2005 inclusive. Results: Primary care population serum potassium was inversely related to ambient temperature. Following the change in phlebotomy practice, the annual percentage of results above reference range (5.2 mmol/L or higher) was reduced from 9% to 6% and the number of results breaching the upper telephoning threshold (5.8 mmol/L or higher) fell from 0.9% to 0.5%. Conclusions: Ensuring that phlebotomists were trained to avoid facilitating venesection by requesting patients to hand grip (fist clench), was associated with lower mean serum potassium results for the primary care patient population and a reduced incidence of hyperkalaemia. It is likely that the contribution of patient fist clenching during phlebotomy to pseudohyperkalaemia has been underestimated.

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The perennial problem with potassium

Cited by 10 publications

References 16 publications

Seasonal pseudohyperkalaemia: no longer an issue?

Seasonal pseudohyperkalaemia: no longer an issue?

Best practice in primary care pathology: review 9

Is suboptimal phlebotomy technique impacting on potassium results for primary care?

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