Download does not reflect the level of plasma k

2. Is this pseudohyperkalemia?
Why or why not?
1955
1960
1966
• First reported phenomenon of pseudohyperkalemia by Hartmann and Mellinkoff
• Marked elevation of serum K+ levels in the absence of clinical evidence of electrolyte
imbalance; non-toxic and no emergency therapy required because elevation of serum
K+ DOES NOT REFLECT THE LEVEL OF PLASMA K+ IN VIVO
• Due to leakage from platelets in vitro during the clotting process
• Nilsson et al
• K could be released from other cellular components and assumed that the red cells
might be the source
• Bronson et al  3 cases of pseudohyperkalemia in chronic myelogenous keukemia in
transformation
• WHITE BLOOD CELL breakdown could case the release of K during coagulation as well
 confusion concerning which cellular component of blood is responsible and why it is
not observed in every case where an increase of this component is present.
Sevastos, N.; Theodossiades, G;Archimandritis, A. Pseudohyperkalemia in Serum: A New Insight into an Old Phenomenon
mid 1980s
• lag time between blood collection and potassium determination
was confined to a maximum of 30 minutes and a positive
correlation between platelet count and serum but not plasma
potassium concentration, was found.
1997
• Singh et al
• that pseudohyperkalemia should only be considered when the
serum potassium level exceeds that of plasma by 0.4 mmol/L
2002
• Fukasawa et al
• that normal counts of activated platelets might also be the cause
 later confirmed that pseudohyperkalemia was attributed to the
presence of activated platelets and observed in a few patients
Sevastos, N.; Theodossiades, G;Archimandritis, A. Pseudohyperkalemia in Serum: A New Insight into an Old Phenomenon
PSEUDOHYPERKALEMIA
• Artificially elevated plasma K+ concentration due to K + movement
out of cells immediately prior to or following venipuncture
• Contributing factors: prolonged use of tourniquet with or without
repeated fist clenching, hemolysis, and marked leukocytosis or
thrombocytosis
• marked leukocytosis or thrombocytosis  results in an elevated
serum K + concentration due to release of intracellular K + following
clot formation
• serum to plasma potassium difference of more than 0.4 mmol/l
• occurs when platelets, leukocytes or erythrocytes release
intracellular potassium in vitrofalsely elevated serum values.
• Observed in:
– Myeloproliferative disorders including leukemia
– Infectious mononucleosis
– Rheumatoid arthritis
Harrison’s Principles of Internal Medicine 17th ed.
Onyekachi Ifudu, Mariana S. Markell, Eli A. Friedman. Unrecognized Pseudohyperkalemia as a Cause of Elevated Potassium in Patients with Renal Disease
2. Is this pseudohyperkalemia?
Why or why not?
NO… this is not pseudohyperkalemia since there are no
enough evidence of blood count differentials as well as no
history predisposing the patient to develop such.
Also, the presence of ECG abnormalities which require
emergency therapy is not a common indication in
pseudohyperkalemia