Unexplained hyperkalemia: The tip of the iceberg

Meka, Naga; Malik, Yahya Osman

doi:10.12659/ajcr.883151

Cited by 3 publications

(3 citation statements)

References 11 publications

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“…A healthy ECG in the proper clinical setting can assist in making the diagnosis at the bedside [6,[11][12]. On the other hand, the second patient must have had undiagnosed polycythemia vera for a long time and such cases of pseudohyperkalemia due to diagnosed and undiagnosed myeloproliferative have been variously reported in the literature [13][14][15][16][17][18]. Following the approval of patiromer and sodium zirconium cyclosilicate, there is now an increased uptake in the prescribing of these agents [7,19].…”

Section: Discussionmentioning

confidence: 99%

Pseudohyperkalemia and the Need for Imperative Caution With the Newly Introduced Potent Potassium Binders: Two Cases

Onuigbo¹,

Ross²

2021

Cureus

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Pseudohyperkalemia was first reported in 1955 by Hartmann and Mellinkoff, as a marked elevation of serum potassium in the absence of clinical evidence of electrolyte imbalance - simultaneous serum potassium exceeds plasma potassium by >0.4 mmol/L. We describe two patients with pseudohyperkalemia who inadvertently received inappropriate potassium binder therapy for weeks to months before the diagnosis of pseudohyperkalemia was entertained and subsequently confirmed. Potassium binders ultimately were promptly discontinued once the diagnosis of pseudohyperkalemia was confirmed. Physicians’ attention must be drawn to the availability of the new potent oral potassium binders, patiromer and sodium zirconium cyclosilicate. We strongly advocate for imperative caution with these new binders. Iatrogenic life-threatening hypokalemia remains a real concern and must be avoided. Our patients highlighted the importance of caution in the use of the newer potent potassium binders to mitigate against the causation of iatrogenic hypokalemia. Also as important is the observation that in the same patient, with changing clinical scenarios, a patient might exhibit true hyperkalemia that alternated with pseudohyperkalemia, the first of such a report.

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Section: Discussionmentioning

confidence: 99%

Pseudohyperkalemia and the Need for Imperative Caution With the Newly Introduced Potent Potassium Binders: Two Cases

Onuigbo¹,

Ross²

2021

Cureus

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“…Forty studies were retrieved from the aforementioned databases. After browsing the titles and abstracts, three cases met the inclusion criteria and were analyzed[ 8 , 10 , 11 ]. In these cases, the patients' age ranged from 50 years to 62 years, and one patient was male.…”

Section: Discussionmentioning

confidence: 99%

Pseudohyperkalemia caused by essential thrombocythemia in a patient with chronic renal failure: A case report

Guo

2020

WJCC

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BACKGROUND Hyperkalemia is one of the most common complications of chronic renal failure. Pseudohyperkalemia is caused by elevated levels of serum potassium in vitro and is usually accompanied by thrombocythemia. Although an elevated level of potassium is typically correlated with impaired renal function, pseudo-hyperkalemia has been rarely reported in patients with chronic renal failure. Here, we conducted a review of the literature to study the case of pseudo-hyperkalemia caused by the essential thrombocythemia in a patient with chronic renal failure. CASE SUMMARY A 73-year-old woman was admitted to our hospital with complaints of palpitation, dyspnea, and acratia for 2 d and a history of essential throm-bocythemia for 1 year. The routine blood test showed platelet count of 1460 × 10 9 /L, and biochemistry tests showed that the patient suffered from hyperkalemia (potassium: 7.50 mmol/L) and renal failure (estimated glomerular filtration rate: 8.88 mL/min). Initial treatment included medicines to lower her potassium-levels and hemodialysis. However, the therapy did not affect her serum potassium levels. Plasma potassium concentration measurements and a history of essential thrombocythemia established the diagnosis of pseudohyperkalemia. The treatments of the platelet disorder gradually normalized serum potassium levels; however, the treatments had to be discontinued later due to the severe leukopenia, and enhanced levels of serum potassium concentrations were observable in the patient. Since plasma sampling was not permitted, doctors had to use a diuretic just in case. Finally, the patient collapsed into unconsciousness and died due to multiple organ dysfunction and electrolyte disturbance. CONCLUSION We reviewed the literature and suggest that serum and plasma potassium values should both be measured for patients whose platelet counts exceed 500 × 10 9 /L to eliminate chances of pseudohyperkalemia, especially for those with chronic renal failure. An inappropriate treatment for pseudohyperkalemia can aggravate a patient's condition.

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“…Third, medications; certain medications commonly prescribed in cancer patients have been associated with hyperkalaemia as the result of hyporeninemic hypoaldosteronism (calcineurin inhibitor), amiloride-like effect (trimethoprim-sulfamethoxazole) and unknown mechanism (axitnib, hydroxyurea and thalidomide) [61][62][63][64][65].…”

Section: Hyperkalaemiamentioning

confidence: 99%

Electrolytes disturbances in cancer patients

Turcotte

Achi

Mamlouk

et al. 2022

Current Opinion in Nephrology &Amp; Hypertension

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Purpose of reviewHypernatremia, hyperphosphatemia, hypocalcaemia, hyperkalaemia and hypermagnesemia are electrolytes disturbances that can arise in cancer patients in relation to unique causes that are related to the cancer itself or its treatment and can lead to delay or interruption of cancer therapy. This article summarizes these main causes, the proposed pathophysiology and the recommended management for these disturbances. Recent findingsThere have been many cancer drugs approved in the field of oncology over the past several years and a subset of these drugs have been associated with electrolytes disturbances. This includes, for example, immune checkpoint inhibitor related hyperkalemia, fibroblast growth factor 23 inhibitor associated hyperphosphatemia and epidermal growth factor receptor inhibitor associated hypomagnesemia and hypocalcaemia. SummaryThis article provides an updated review of certain electrolytes disturbance in cancer patients and allows clinicians to have a greater awareness and knowledge of these electrolyte abnormalities in efforts to early recognition and timely management.

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Unexplained hyperkalemia: The tip of the iceberg

Cited by 3 publications

References 11 publications

Pseudohyperkalemia and the Need for Imperative Caution With the Newly Introduced Potent Potassium Binders: Two Cases

Pseudohyperkalemia and the Need for Imperative Caution With the Newly Introduced Potent Potassium Binders: Two Cases

Pseudohyperkalemia caused by essential thrombocythemia in a patient with chronic renal failure: A case report

Electrolytes disturbances in cancer patients

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