|
 
 |
| REVIEW ARTICLE |
|
| Year : 2013 | Volume
: 5
| Issue : 4 | Page : 255-259 |
|
Errors in potassium measurement: A laboratory perspective for the clinician
Jaya R Asirvatham1, Viju Moses2, Loring Bjornson1
1 Department of Pathology, Hofstra North Shore-Long Island Jewish School of Medicine, New York, USA
2 Saint Peter's University Hospital/Drexel University School of Medicine, New Brunswick, USA
| Date of Web Publication | 11-Apr-2013 |
Correspondence Address:
Jaya R Asirvatham
6 Ohio Drive, Ste 202, Lake Success 11040, New York
USA
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/1947-2714.110426
Errors in potassium measurement can cause pseudohyperkalemia, where serum potassium is falsely elevated. Usually, these are recognized either by the laboratory or the clinician. However, the same factors that cause pseudohyperkalemia can mask hypokalemia by pushing measured values into the reference interval. These cases require a high-index of suspicion by the clinician as they cannot be easily identified in the laboratory. This article discusses the causes and mechanisms of spuriously elevated potassium, and current recommendations to minimize those factors. "Reverse" pseudohyperkalemia and the role of correction factors are also discussed. Relevant articles were identified by a literature search performed on PubMed using the terms "pseudohyperkalemia," "reverse pseudohyperkalemia," "factitious hyperkalemia," "spurious hyperkalemia," and "masked hypokalemia." Keywords: Factitious hyperkalemia, Hemolysis, Potassium, Pseudohyperkalemia, Reverse pseudohyperkalemia, Spurious hyperkalemia
How to cite this article:
Asirvatham JR, Moses V, Bjornson L. Errors in potassium measurement: A laboratory perspective for the clinician. North Am J Med Sci 2013;5:255-9 |
How to cite this URL:
Asirvatham JR, Moses V, Bjornson L. Errors in potassium measurement: A laboratory perspective for the clinician. North Am J Med Sci [serial online] 2013 [cited 2023 Mar 26];5:255-9. Available from: https://www.najms.org/text.asp?2013/5/4/255/110426 |
| Introduction | |  |
It has been estimated that 60-70% of clinical decisions are based on laboratory results and potassium is among the ten most commonly tested analytes. [1] About 4-32% of all laboratory errors occur during the analytical phase of testing the sample. The majority of errors (32-75%) occur before the sample is analyzed: During labeling, collection, transport or centrifugation. [2] The rest of the errors occur during report generation or interpretation. This article discusses the causes and mechanisms of spuriously elevated potassium, and current recommendations to minimize those factors. Masked hypokalemia, reverse pseudohyperkalemia and the role of correction factors are also discussed.
| Measurement of Potassium | | |
Potassium is usually measured using an Ion-selective electrode (ISE), which converts the activity (or effective concentration) of the ion dissolved in solution into an electric potential measured by a voltmeter. Both plasma and serum can be used to measure potassium. Samples can be collected in plain silicone coated glass/plastic tubes, gel separator tubes with or without clot activator for serum estimations (with thrombin-based clot activator for stat estimations) or in tubes containing lithium/sodium/ammonium heparin as an anticoagulant for plasma estimations with or without gel separator. Platelets release potassium during the clotting process, resulting in higher (0.36 ± 0.18 mmol/L) potassium concentrations in the serum as compared to plasma. [3] Pseudohyperkalemia is suspected when the laboratory value of the measured potassium is high but the patient does not manifest signs of hyperkalemia such as abnormal electrocardiogram. Some authors have tried to define pseudohyperkalemia as a difference between serum and plasma potassium concentrations of more than 0.4 mmol/L when samples remain at room temperature and are tested within an hour of collection. [4] The source of potassium is usually cells but can be contaminants. Since 98% of body potassium is intracellular, a small release of potassium can significantly affect the concentration of measured (extracellular) potassium. The ratio between intracellular and extracellular potassium is approximately 40:1 and a change in the ratio as small as 2.5% will increase the potassium concentration by 0.1 mEq/L. [5] Constituents of blood (red blood cells [RBC], white blood cells [WBC], platelets) and skeletal muscle release intracellular potassium either due to faulty collection techniques or disease states. The most common cause of cellular release is cell lysis, which can involve RBC (hemolysis), WBC (leukocytolysis), platelets (thrombocytolysis) or all the three (pancytolysis).
| Causes of Pseudohyperkalemia | | |
Mechanical factors
A tourniquet applied for prolonged periods of more than 1 min causes hemo concentration, altered water balance and hemolysis. Fist clenching is not recommended as it causes local release of potassium from the forearm muscle and increased blood flow. [6],[7],[8] In one study, the measured potassium in the pumping hand was 1.04 mmol/L higher compared to a simultaneously measured non-pumping hand. [6] Traumatic venipuncture or probing, inappropriate needle diameter, excessive force with syringe draws either during aspiration or transfer, increased turbulence due to diameter mismatch of catheter, tube adapter device and needle can all result in hemolysis and pseudohyperkalemia. [2],[6] Cases of pseudohyperkalemia due to pneumatic tube transport/unpadded canisters have been reported, especially in disease states with fragile cell membranes such as leukemia. [9],[10] Mechanical force during specimen processing such as vigorous mixing, excessive centrifugal force, prolonged fixed angle centrifugation or re-centrifugation of gel separator tubes also need to be considered. [2],[6]
Chemical factors
If ethanol containing antiseptics are not allowed to dry completely before venipuncture, the solution can enter the blood stream and disrupt cell membranes. [2]
Temperature
Cold temperature inhibits the sodium potassium pump resulting in leakage of potassium. Higher temperatures initially decrease and then increase potassium concentrations, probably related to increased usage and exhaustion of glucose that generates adenosine triphosphate (ATP) for the sodium-potassium pump. Recommended temperature for specimen storage prior to testing is 15-25°C. [2] Specimens should not be stored between 2°C and 8°C, or above room temperature for more than 24 h. [2] Elevations in potassium more commonly observed in samples from doctors' offices compared to inpatient or laboratory collections, attributed to changes in temperature that the sample is exposed to during transport in winter, have been dubbed "Seasonal Pseudohyperkalemia." [11],[12]
Time
Delayed processing, results in exhaustion of available glucose to generate ATP. Since ATP fuels the sodium potassium pump and maintains the gradient across the cell membrane, failure of the pump results in leakage of potassium out of the cell, resulting in pseudohyperkalemia.
Patient factors
Fear of imminent venipuncture or crying associated with hyperventilation (even for 3-6 min) is associated with acute respiratory alkalosis, which results in a significant hyperkalemic response mediated by enhanced alpha-adrenergic activity. Though the exact cellular mechanism is not known, animal models suggest a role for alpha receptor mediated activation of hepatic calcium dependent potassium channels. [13]
Thrombocytosis results in increased release of potassium during the clotting process. Sevatos, et al. examined platelet count and release of potassium during the clotting process and found an average increase of 0.82 mmol/L (range of platelet count: 400-1500 × 10 3 /mm 3 ). However, the increase was not proportional: There was an initial linear increase at higher levels of platelets followed by a drop, presumably caused by re-entry of potassium into RBC to maintain homeostasis. [14] The increase was more profound in thrombocytosis and mixed RBC disorders compared to pure erythrocytosis. Factitious hyperkalemia may be seen in WBC neoplasms due to increased membrane fragility and little reserve capacity for withstanding mechanical agitation or by leakage into the serum. [10] It is suspected that neoplastic WBC membranes (e.g., chronic lymphocytic leukemia) are more likely to be leaky or to be disrupted during pneumatic chute transport. Another factor is that at high-levels of leukocytosis, there is increased consumption (and thereby exhaustion) of metabolites that fuel the ATP pump.
As the spleen is a major reserve for platelets, post-splenectomy status has also been reported to be associated with pseudohyperkalemia. [15],[16] In patients with chronic renal failure, pseudohyperkalemia due to co-existing myeloproliferative neoplasm was identified only when therapy failed to reduce potassium concentration. [17],[18]
Familial pseudohyperkalemia is an autosomal dominant disorder characterized by abnormal passive outward leakage of potassium across the RBC membrane. It is an in-vitro phenomenon, occurring when blood is stored at room temperature. [19],[20]
Contaminants
Potassium containing IV fluids are common contaminants as are potassium salts of tube additives. If the recommended order of draw during phlebotomy is not maintained, carryover and back flow of potassium salts of tube additives such as ethylenediamine tetra-acetic acid (EDTA) or oxalate can elevate measured potassium. The recommended (simplified) order of draw is: Culture tubes followed by sodium citrate tubes, serum tubes (with or without clot activator/gel separator), heparin tubes, EDTA tubes, and sodium fluoride tubes.
Povidone iodine in one study has been associated with increase in measured potassium up to 1 mmol/L, the mechanism of which is unknown. [21] Contaminants can also interfere with the ion-selective electrode that measures potassium. For example, Benzalkonium heparin, a chemical used to coat catheters in IV-access devices to decrease thrombus formation and infections, interfered with electrodes in an older generation of instruments that measured potassium indirectly using a diluted sample. [22],[23]
Miscellaneous causes
Using plasma reference ranges to interpret serum values could result in pseudohyperkalemia. Mislabeling of patient samples should be excluded.
| Reverse Pseudohyperkalemia | | |
Reverse pseudohyperkalemia is when plasma potassium is falsely high but the serum potassium is normal. [24],[25],[26] This phenomenon has been reported in samples of patients with leukemia/lymphoma. In one study, the plasma potassium concentration of a sample collected in a lithium heparin tube was 6.0 mmol/L higher than simultaneously measured serum potassium concentration. [26] The degree of increase in potassium was directly related to the amount of heparin. Potassium measured using a heparin coated syringe which contains about one-third the amount of heparin in a tube, did not cause an increase in plasma potassium. There was no evidence of hemolysis, suggesting a non-RBC source of potassium. It is postulated that neoplastic WBC membranes are especially sensitive to disruption by heparin, the anticoagulant used for plasma estimations. High values of potassium and lactate dehydrogenase (LDH) in the absence of hemolysis might indicate in-vitro lysis of WBC.
| Masked Hypokalemia | | |
The same factors that cause pseudohyperkalemia can mask hypokalemia by pushing the measured potassium of a hypokalemic patient into the reference interval. These cases are not easily identified as they require a high index of suspicion by the clinician. [4],[27] In one study, more than a third of hypokalemic cases were missed due to hemolysis when using whole blood to estimate potassium. [28] Re-evaluation of cases of suspected hypokalemia with serum/plasma concentrations of potassium within the reference range might be indicated especially, in the setting of a high Hemolysis Index (HI). The HI is a semi-quantitative measurement of the concentration of free hemoglobin in mg/dL.
| Correction Factors | | |
Several researchers have attempted to quantify potassium release during hemolysis using indices such as the serum or plasma free hemoglobin concentration, -I), Mean Corpuscular Hemoglobin Concentration (MCHC) or HI multiplied by a constant (e.g., Corrected K + = Measured K + -(HI × 0.004). Though some have found a linear relationship between potassium elevation and degree of hemolysis, others have not. [29],[30],[31],[32],[33],[34],[35],[36] Correction factors for platelet counts have also been proposed. [37] A quantitative corrected potassium result may be unreliable as pseudohyperkalemia can be caused by the interplay of several factors that may not be measurable. However, these correction factors might have a role in estimating the likelihood of potassium being low, high or within the reference interval, in the interest of patient care, where a repeat sample would be difficult, if not impossible to obtain. [28]
| Whole Blood Testing | | |
The need for rapid accurate assessment of potassium in critically ill patients where the expected turnaround time is in the order of a few minutes has led to the use of blood gas analyzers and point of care testing using whole blood. Investigators have analyzed the interchangeability of electrolytes measured with point of care, blood gas, and central laboratory analyzers. Some have found stat measurements using whole blood to be comparable to laboratory analyzers using serum/plasma. [38],[39]
Interestingly Chacko, et al. [40] found that while agreement between whole blood and serum was good, differences were large and clinically significant at concentrations below 3 mmol/L (whole blood measurements were up to 1 mmol/L lower compared to serum). The authors had used plastic lithium coated ABG syringes (DRIHEP A-LINE arterial blood gas collection syringe, 3.0 mL volume, 1.6 mL recommended draw Becton Dickinson Diagnostics® , Plymouth, UK) for blood gas analysis to minimize the effect of heparin flushes and also determined that their pneumatic system did not significantly alter the electrolyte values. The authors proposed electrode differences as one of the probable causes for the difference: Direct ISE (GEM 3000® ABG analyzer) for on-site assessment compared to indirect ISE in central laboratory analyzers (Olympus AU2700 discrete chemistry analyzer, Olympus Optical Company, Ltd., Japan) which can be affected by dissolved solids such as proteins. The authors caution against over/underestimating therapeutic effect when comparing potassium concentrations from two different sample types/analyzers.
In another study, Hawkins, et al. [28] demonstrated that over 33% of hypokalemic cases were missed when using whole blood to determine potassium concentration. Moreover, hand disinfectants have been shown to significantly elevate potassium concentration especially when direct ion selective electrodes were used in point of care testing of whole blood samples.
| Conclusion | | |
There are several factors which singly or in combination can contribute to a spurious elevation of measured potassium or mask hypokalemia by pushing the measured potassium into the reference interval. Potassium is predominantly intracellular; hence small shifts can cause large changes in the measured value. Efforts must be made to minimize these factors. In addition, clinicians must have a high-index of suspicion when the measured potassium is sharply discordant from prior readings, or when the laboratory values are not concordant with the clinical picture. If pseudohyperkalemia is suspected, the laboratory should be consulted, so that appropriate samples can be submitted and investigations performed.
| References | | |
| 1. | Forsman RW. Why is the laboratory an afterthought for managed care organizations? Clin Chem 1996;42:813-6. 
|
| 2. | Stankovic AK, Smith S. Elevated serum potassium values: The role of preanalytic variables. Am J Clin Pathol 2004;121:S105-12.
|
| 3. | Nijsten MW, de Smet BJ, Dofferhoff AS. Pseudohyperkalemia and platelet counts. N Engl J Med 1991;325:1107.
|
| 4. | Sevastos N, Theodossiades G, Archimandritis AJ. Pseudohyperkalemia in serum: A new insight into an old phenomenon. Clin Med Res 2008;6:30-2.
|
| 5. | Serum Potassium-Clinical Methods-NCBI Bookshelf, Rastegar A. Serum Potassium. In: Walker HK, Hall WD, Hurst JW, editors. Clinical Methods: The History, Physical, and Laboratory Examinations. 3 rd ed. Chapter 195. Boston: Butterworths; 1990.
|
| 6. | Baer DM, Ernst DJ, Willeford SI, Gambino R. Investigating elevated potassium values. MLO Med Lab Obs 2006;38:24, 26, 30-1.
|
| 7. | Bailey IR, Thurlow VR. Is suboptimal phlebotomy technique impacting on potassium results for primary care? Ann Clin Biochem 2008;45:266-9.
|
| 8. | Saleem S, Mani V, Chadwick MA, Creanor S, Ayling RM. A prospective study of causes of haemolysis during venepuncture: Tourniquet time should be kept to a minimum. Ann Clin Biochem 2009;46:244-6.
|
| 9. | Guiheneuf R, Vuillaume I, Mangalaboyi J, Launay D, Berthon C, Maury JC, et al. Pneumatic transport is critical for leukaemic patients with major leukocytosis: What precautions to measure lactate dehydrogenase, potassium and aspartate aminotransferase? Ann Clin Biochem 2010;47:94-6.
|
| 10. | Kellerman PS, Thornbery JM. Pseudohyperkalemia due to pneumatic tube transport in a leukemic patient. Am J Kidney Dis 2005;46:746-8.
|
| 11. | Sinclair D, Briston P, Young R, Pepin N. Seasonal pseudohyperkalaemia. J Clin Pathol 2003;56:385-8.
|
| 12. | Turner HE, Peake RW, Allison JJ. Seasonal pseudohyperkalaemia: No longer an issue? Ann Clin Biochem 2012;49:94-6.
|
| 13. | Krapf R, Caduff P, Wagdi P, Stäubli M, Hulter HN. Plasma potassium response to acute respiratory alkalosis. Kidney Int 1995;47:217-24.
|
| 14. | Sevastos N, Theodossiades G, Efstathiou S, Papatheodoridis GV, Manesis E, Archimandritis AJ. Pseudohyperkalemia in serum: The phenomenon and its clinical magnitude. J Lab Clin Med 2006;147:139-44.
|
| 15. | Ahmed R, Isaac AM. Postsplenectomy thrombocytosis and pseudohyperkalemia in trauma: A case report and review of literature. J Trauma 2009;67:E17-9.
|
| 16. | Lambertucci JR, Otoni A, Rodrigues VL. Pseudohyperkalemia and pseudohyperphosphatemia after splenectomy in hepatosplenic schistosomiasis mansoni. Rev Soc Bras Med Trop 2008;41:692.
|
| 17. | Fukasawa H, Furuya R, Kato A, Yonemura K, Fujigaki Y, Yamamoto T, et al. Pseudohyperkalemia occurring in a patient with chronic renal failure and polycythemia vera without severe leukocytosis or thrombocytosis. Clin Nephrol 2002;58:451-4.
|
| 18. | Ifudu O, Markell MS, Friedman EA. Unrecognized pseudohyperkalemia as a cause of elevated potassium in patients with renal disease. Am J Nephrol 1992;12:102-4.
|
| 19. | Sugimoto T, Kume S, Osawa N, Nakazawa J, Koya D, Kashiwagi A. Familial pseudohyperkalemia: A rare cause of hyperkalemia. Intern Med 2005;44:875-8.
|
| 20. | Kitamura K, Tomita K. Familial pseudohyperkalemia: A rare syndrome, but diverse genetic heterogeneity. Intern Med 2005;44:781-2.
|
| 21. | Van Steirteghem AC, Young DS. Povidone-iodine ("Betadine") disinfectant as a source of error. Clin Chem 1977;23:1512.
|
| 22. | Koch TR, Cook JD. Benzalkonium interference with test methods for potassium and sodium. Clin Chem 1990;36:807-8.
|
| 23. | Gaylord MS, Pittman PA, Bartness J, Tuinman AA, Lorch V. Release of benzalkonium chloride from a heparin-bonded umbilical catheter with resultant factitious hypernatremia and hyperkalemia. Pediatrics 1991;87:631-5.
|
| 24. | Garwicz D, Karlman M. Early recognition of reverse pseudohyperkalemia in heparin plasma samples during leukemic hyperleukocytosis can prevent iatrogenic hypokalemia. Clin Biochem 2012;45:1700-2.
|
| 25. | Garwicz D, Karlman M, Øra I. Reverse pseudohyperkalemia in heparin plasma samples from a child with T cell acute lymphoblastic leukemia with hyperleukocytosis. Clin Chim Acta 2011;412:396-7.
|
| 26. | Meng QH, Krahn J. Reverse pseudohyperkalemia in heparin plasma samples from a patient with chronic lymphocytic leukemia. Clin Biochem 2011;44:728-30.
|
| 27. | Gambino R, Sanfilippo M, Lazcano L. Pseudohyperkalaemia from finger flexion during venepuncture masks true hypokalaemia. Ann Clin Biochem 2009;46:177. Hawkins R. Measurement of whole-blood potassium: Is it clinically safe? Clin Chem 2003;49:2105-6.
|
| 28. | Dimeski G, Clague AE, Hickman PE. Correction and reporting of potassium results in haemolysed samples. Ann Clin Biochem 2005;42:119-23.
|
| 29. | Owens H, Siparsky G, Bajaj L, Hampers LC. Correction of factitious hyperkalemia in hemolyzed specimens. Am J Emerg Med 2005;23:872-5.
|
| 30. | Jeffery J, Sharma A, Ayling RM. Detection of haemolysis and reporting of potassium results in samples from neonates. Ann Clin Biochem 2009;46:222-5.
|
| 31. | Mansour MM, Azzazy HM, Kazmierczak SC. Correction factors for estimating potassium concentrations in samples with in vitro hemolysis: A detriment to patient safety. Arch Pathol Lab Med 2009;133:960-6.
|
| 32. | Hishiki K, Toyama M, Sato R, Suzuki I, Kisugi R, Koike M, et al. Draft proposal to estimate true values of serum potassium in samples from patients with myeloproliferative neoplasma. Rinsho Byori 2012;60:516-22.
|
| 33. | Brescia V, Tampoia M, Mileti A. Evaluation of factitious hyperkalemia in hemolytic samples: Impact of the mean corpuscular hemoglobin concentration. Lab Med 2009;40:224-6.
|
| 34. | Hawkins R. Variability in potassium/hemoglobin ratios for hemolysis correction. Clin Chem 2002;48:796.
|
| 35. | Shepherd J, Warner MH, Poon P, Kilpatrick ES. Use of haemolysis index to estimate potassium concentration in in-vitro haemolysed serum samples. Clin Chem Lab Med 2006;44:877-9.
|
| 36. | Kim HJ, Chung CH, Moon CO, Park CG, Hong SP, Oh MS, et al. Determinants of magnitude of pseudohyperkalemia in thrombocytosis. Korean J Intern Med 1990;5:97-100.
|
| 37. | Leino A, Kurvinen K. Interchangeability of blood gas, electrolyte and metabolite results measured with point-of-care, blood gas and core laboratory analyzers. Clin Chem Lab Med 2011;49:1187-91.
|
| 38. | Steinfelder-Visscher J, Teerenstra S, Gunnewiek JM, Weerwind PW. Evaluation of the i-STAT point-of-care analyzer in critically ill adult patients. J Extra Corpor Technol 2008;40:57-60.
|
| 39. | Chacko B, Peter JV, Patole S, Fleming JJ, Selvakumar R. Electrolytes assessed by point-of-care testing-Are the values comparable with results obtained from the central laboratory? Indian J Crit Care Med 2011;15:24-9.
[PUBMED]  |
| 40. | Lam HS, Chan MH, Ng PC, Wong W, Cheung RC, So AK, et al. Are your hands clean enough for point-of-care electrolyte analysis? Pathology 2005;37:299-304.
|
| This article has been cited by | | 1 |
Implications of differences between point-of-care blood gas analyser and laboratory analyser potassium results on hyperkalaemia diagnosis & treatment |
|
| Jasmin Pradhan, Andrew M. Harding, Simone E. Taylor, Que Lam | | Internal Medicine Journal. 2023; | | [Pubmed] | [DOI] | | | 2 |
Markedly increased small-sized megakaryocytes and platelets count in the circulation with pseudo-hyperkalemia following splenectomy |
|
| Guiying Li, Bin Wang, Dongyan Li, Rong Zhu, Xueyan Chen | | European Journal of Medical Research. 2022; 27(1) | | [Pubmed] | [DOI] | | | 3 |
The The Effect of Variations of Serum Examination Time Lapse on Electrolyte Levels of Potassium and Chloride |
|
| Nur Indah Nila Asri, Andika Aliviameita | | Medicra (Journal of Medical Laboratory Science/Technology). 2022; 5(2): 119 | | [Pubmed] | [DOI] | | | 4 |
Is There a Risk of Misinterpretation of Potassium Concentration from Undetectable Hemolysis Using a POCT Blood Gas Analyzer in the Emergency Department? |
|
| Marianna Nigro, Gabriele Valli, Maria Luisa Marchionne, Dario Sattarinia, Fabiana Silvestrini, Daniele De Pietro, Simone Fazzini, Giorgia Roselli, Andrea Spallino, Valentina Praticò, Enrico Mirante, Ersilia Castaldo, Francesco Rocco Pugliese, Claudia Cicchini, Carlo Ancona, Francesca De Marco, Maria Pia Ruggieri, Salvatore Di Somma | | Medicina. 2022; 59(1): 66 | | [Pubmed] | [DOI] | | | 5 |
Cells Gone Wild: A Case Report on Missed Acute Leukemia and Subsequent Disseminated Intravascular Coagulation in the Emergency Department |
|
| Onyinyechukwu Okorji, Rachael Kern, Shaylor Klein, Brian Jordan, Kuljit Kaur | | Clinical Practice and Cases in Emergency Medicine. 2022; 6(4): 306 | | [Pubmed] | [DOI] | | | 6 |
Pseudohyperkalemia Associated With Leukemia |
|
| Biraj Shrestha, Swarup Sharma Rijal, Arpan Pokhrel, Anish Paudel, Krantikiran Baral, Bidhya Poudel, Sijan Basnet, Anthony Donato | | Cureus. 2022; | | [Pubmed] | [DOI] | | | 7 |
Unexpected hyperkalaemia in an anaesthetised calf undergoing umbilical fistula resection |
|
| Ana Gonzalez Gomez, Adam Auckburally, Regula Bettschart-Wolfensberger | | Veterinary Record Case Reports. 2022; | | [Pubmed] | [DOI] | | | 8 |
Adding eosinophil count to EMERALD rules predicts subarachnoid haemorrhage better in emergency department |
|
| Adem Kaya, Salim Satar, Muge Gulen, Selen Acehan, Kemal Alper Afser, Hakan Demirhindi | | Irish Journal of Medical Science (1971 -). 2022; | | [Pubmed] | [DOI] | | | 9 |
Impact of recentrifugation of blood collection tubes on chemistry and immunochemistry analytes after 24 and 72 hours of refrigerated storage on the Roche Cobas 8000 platform |
|
| Raffick A.R. Bowen, Vanessa Esguerra, Maria Walker, Phil Cheng, Thanh Nguyen | | Clinica Chimica Acta. 2022; 531: 342 | | [Pubmed] | [DOI] | | | 10 |
Point-of-care and self-testing for potassium: recent advances |
|
| Tanya Hutter, Thomas S. Collings, Gratsiela Kostova, Fiona E. Karet Frankl | | Sensors & Diagnostics. 2022; | | [Pubmed] | [DOI] | | | 11 |
Hematological Malignancies and the Kidney |
|
| Matthew Abramson, Ali Mehdi | | Advances in Chronic Kidney Disease. 2022; 29(2): 127 | | [Pubmed] | [DOI] | | | 12 |
Role of Acacia catechu and Scutellaria baicalensis in Enhancing Immune Function Following Influenza Vaccination of Healthy Adults: A Randomized, Triple-Blind, Placebo-Controlled Clinical Trial |
|
| Erin D. Lewis, David C. Crowley, Najla Guthrie, Malkanthi Evans | | Journal of the American Nutrition Association. 2022; : 1 | | [Pubmed] | [DOI] | | | 13 |
Point-of-care artificial intelligence-enabled ECG for dyskalemia: a retrospective cohort analysis for accuracy and outcome prediction |
|
| Chin Lin, Tom Chau, Chin-Sheng Lin, Hung-Sheng Shang, Wen-Hui Fang, Ding-Jie Lee, Chia-Cheng Lee, Shi-Hung Tsai, Chih-Hung Wang, Shih-Hua Lin | | npj Digital Medicine. 2022; 5(1) | | [Pubmed] | [DOI] | | | 14 |
Exploring the K isotope composition of Göttingen minipig brain regions, and implications for Alzheimer's disease |
|
| Brandon Mahan, Theo Tacail, Jamie Lewis, Tim Elliott, Mette Habekost, Simon Turner, Roger Chung, Frédéric Moynier | | Metallomics. 2022; 14(12) | | [Pubmed] | [DOI] | | | 15 |
Incidental findings in UK healthy volunteers screened for a COVID-19 vaccine trial |
|
| Susanne H. Hodgson, Poppy Iveson, Jessica Larwood, Sophie Roche, Hazel Morrison, Catherine Cosgrove, Eva Galiza, Sabina Ikram, Nana-Marie Lemm, Savviz Mehdipour, Daniel Owens, Mihaela Pacurar, Michael Schumacher, Robert H. Shaw, Saul N. Faust, Paul T. Heath, Andrew J. Pollard, Katherine R. W. Emary, Katrina M. Pollock, Rajeka Lazarus | | Clinical and Translational Science. 2021; | | [Pubmed] | [DOI] | | | 16 |
Update on management of hypokalaemia and goals for the lower potassium level in patients with cardiovascular disease: a review in collaboration with the European Society of Cardiology Working Group on Cardiovascular Pharmacotherapy |
|
| Maria Lukács Krogager,Kristian Kragholm,Jesper Qvist Thomassen,Peter Søgaard,Basil S Lewis,Sven Wassmann,Iris Baumgartner,Claudio Ceconi,Thomas Andersen Schmidt,Juan Carlos Kaski,Heinz Drexel,Anne Grete Semb,Stefan Agewall,Alexander Niessner,Gianluigi Savarese,Keld Per Kjeldsen,Claudio Borghi,Juan Tamargo,Christian Torp-Pedersen | | European Heart Journal - Cardiovascular Pharmacotherapy. 2021; | | [Pubmed] | [DOI] | | | 17 |
Epidemiology, prognosis and management of potassium disorders in Covid-19 |
|
| Maryam Noori,Seyed A. Nejadghaderi,Mark J. M. Sullman,Kristin Carson-Chahhoud,Ali-Asghar Kolahi,Saeid Safiri | | Reviews in Medical Virology. 2021; | | [Pubmed] | [DOI] | | | 18 |
Hemolyzed Blood Samples in the Emergency Department - Finding Our “Why” |
|
| Hayley Harvey,Alexis Webster,Matthew Wilson | | Journal of Emergency Nursing. 2021; 47(4): 524 | | [Pubmed] | [DOI] | | | 19 |
The Role of Using Red-Topped - Non-Additive-Containing - Collecting Tube in Diagnosing Pseudohyperkalemia in Chronic Lymphocytic Leukemia |
|
| Ahmed Abdulrahim,Mohamedanwar Ghandour,Abu-Bekr Mohamed,Lobelia Samavati | | Cureus. 2021; | | [Pubmed] | [DOI] | | | 20 |
Randomized Trial on the Effects of Dietary Potassium on Blood Pressure and Serum Potassium Levels in Adults with Chronic Kidney Disease |
|
| Sharon Turban,Stephen P. Juraschek,Edgar R. Miller,Cheryl A. M. Anderson,Karen White,Jeanne Charleston,Lawrence J. Appel | | Nutrients. 2021; 13(8): 2678 | | [Pubmed] | [DOI] | | | 21 |
Nano-Interstice Driven Powerless Blood Plasma Extraction in a Membrane Filter Integrated Microfluidic Device |
|
| Jaehoon Kim,Junghyo Yoon,Jae-Yeong Byun,Hyunho Kim,Sewoon Han,Junghyun Kim,Jeong Hoon Lee,Han-Sang Jo,Seok Chung | | Sensors. 2021; 21(4): 1366 | | [Pubmed] | [DOI] | | | 22 |
Effects of handling and storage on potassium concentration in plasma and serum samples obtained from cats |
|
| Briana M. Domenegato, Etienne Côté, Deepmala Agarwal, M. Lynne O’Sullivan, Elaine D. Reveler, Elizabeth Dobbin, Ellen McMahon | | Journal of the American Veterinary Medical Association. 2021; : 1 | | [Pubmed] | [DOI] | | | 23 |
The effect of drone transport on the stability of biochemical, coagulation and hematological parameters in healthy individuals |
|
| Desirée Perlee,Klaas Henk van der Steege,Gijs den Besten | | Clinical Chemistry and Laboratory Medicine (CCLM). 2021; 0(0) | | [Pubmed] | [DOI] | | | 24 |
Glucose Concentrations in Closely Related Titmice (Baeolophus) Species Linked to Regional Habitat Differences Across an Avian Hybrid Zone |
|
| Jennifer C. Vaughn,Gary Voelker,J. Jill Heatley | | The Open Ornithology Journal. 2020; 13(1): 10 | | [Pubmed] | [DOI] | | | 25 |
The potential role of the eGFR in differentiating between true and pseudohyperkalaemia |
|
| Thomas G Morris,Sushmita Lamba,Thomas Fitzgerald,Gary Roulston,Helen Johnstone,Mehdi Mirzazadeh | | Annals of Clinical Biochemistry: International Journal of Laboratory Medicine. 2020; 57(6): 444 | | [Pubmed] | [DOI] | | | 26 |
Short-term mortality risk of different plasma potassium levels in patients treated with combination antihypertensive therapy |
|
| Maria L Krogager,Christian Torp-Pedersen | | European Journal of Preventive Cardiology. 2020; | | [Pubmed] | [DOI] | | | 27 |
Preliminary study on the correlation of plasma hemolysis index and potassium measurement of inpatient in the Biochemistry Laboratory of General Hospital Kuala Lumpur |
|
| Chia Zhen Zhan,Asma Harun,Mohd Nazil Salleh | | Life Sciences, Medicine and Biomedicine. 2020; 4(9) | | [Pubmed] | [DOI] | | | 28 |
Differentiating Pseudohyperkalemia From True Hyperkalemia in a Patient With Chronic Lymphocytic Leukemia and Diverticulitis |
|
| John Dewey,Joshua Mastenbrook,Laura D Bauler | | Cureus. 2020; | | [Pubmed] | [DOI] | | | 29 |
Accuracy of Hemolyzed Potassium Levels in the Emergency Department |
|
| Matt Wilson,Sam Adelman,JB Maitre,Joe Izzo,Ronald Valencia,Mike Yang,Jeff Dubin,Munish Goyal | | Western Journal of Emergency Medicine. 2020; 21(6) | | [Pubmed] | [DOI] | | | 30 |
Technical note: Effect of delayed analysis of cooled lithium-heparinized whole blood on the stability of ionized calcium, ionized magnesium, sodium, potassium, chloride, glucose, and lactate in samples from dairy cows |
|
| P.R. Menta,T.A. Batchelder,R.C. Neves | | Journal of Dairy Science. 2020; | | [Pubmed] | [DOI] | | | 31 |
Pseudohyperkalemia in Serum and Plasma: The Phenomena and Its Clinical Implications |
|
| Mala Mahto,Mukunda Kumar,Sushil Kumar,Ayan Banerjee | | Indian Journal of Clinical Biochemistry. 2020; | | [Pubmed] | [DOI] | | | 32 |
Potassium infusion increases the likelihood of conversion of recent-onset atrial fibrillation—A single-blinded, randomized clinical trial |
|
| Kiarash Tazmini,Mai S. Aa. Fraz,Ståle H. Nymo,Mathis K. Stokke,William E. Louch,Erik Øie | | American Heart Journal. 2020; 221: 114 | | [Pubmed] | [DOI] | | | 33 |
Management of hyperkalemia during treatment with mineralocorticoid receptor blockers: findings from esaxerenone |
|
| Hiromi Rakugi,Satoru Yamakawa,Kotaro Sugimoto | | Hypertension Research. 2020; | | [Pubmed] | [DOI] | | | 34 |
The Impact of Undetected In Vitro Hemolysis or Sample Contamination on Patient Care and Outcomes in Point-of-Care Testing: A Retrospective Study |
|
| Matthew O’Hara,Elizabeth G Wheatley,Steven C Kazmierczak | | The Journal of Applied Laboratory Medicine. 2020; | | [Pubmed] | [DOI] | | | 35 |
Potassium disturbance associated with an inpatient childhood asthma pathway |
|
| Jonathan Hung,Timothy Kraft,Brent Seefried,David W Johnson,Michelle Bailey,Deonne Dersch-Mills | | Paediatrics & Child Health. 2019; | | [Pubmed] | [DOI] | | | 36 |
Big data analysis reveals the existence of seasonal pseudohyperkalaemia even in temperate climates |
|
| Ashlin Rampul,Dipak Nowrungsah,Savathree Madurai,Tahir S. Pillay | | Clinica Chimica Acta. 2019; 497: 110 | | [Pubmed] | [DOI] | | | 37 |
HEALTH SURVEY OF BOREAL CARIBOU (RANGIFER TARANDUS CARIBOU) IN NORTHEASTERN BRITISH COLUMBIA, CANADA |
|
| Kristin J. Bondo,Bryan Macbeth,Helen Schwantje,Karin Orsel,Diane Culling,Brad Culling,Morten Tryland,Ingebjørg H. Nymo,Susan Kutz | | Journal of Wildlife Diseases. 2019; | | [Pubmed] | [DOI] | | | 38 |
Réponse à la lettre à l’éditeur : la physiopathologie au service du traitement de l’hyperkaliémie |
|
| L. Lemoine,M. Legrand,G. Potel,P. Rossignol,E. Montassier | | Annales françaises de médecine d’urgence. 2019; | | [Pubmed] | [DOI] | | | 39 |
Microfluidic DNA-based potassium nanosensors for improved dialysis treatment |
|
| Alexander F. Smith,Bin Zhao,Mingxu You,Juan M. Jiménez | | BioMedical Engineering OnLine. 2019; 18(1) | | [Pubmed] | [DOI] | | | 40 |
Pseudohyperkalemia: Hyperkalemia Cocktail or Alternative Diagnosis |
|
| Sanjay Prakash Neupane,Pratibha Sharma,Mahesh Mani Dangal | | Case Reports in Medicine. 2018; 2018: 1 | | [Pubmed] | [DOI] | | | 41 |
Serum potassium as a predictor of adverse clinical outcomes in patients with chronic kidney disease: new risk equations using the UK clinical practice research datalink |
|
| Hans Furuland,Phil McEwan,Marc Evans,Cecilia Linde,Daniel Ayoubkhani,Ameet Bakhai,Eirini Palaka,Hayley Bennett,Lei Qin | | BMC Nephrology. 2018; 19(1) | | [Pubmed] | [DOI] | | | 42 |
Blood sample quality |
|
| Giuseppe Lippi,Alexander von Meyer,Janne Cadamuro,Ana-Maria Simundic | | Diagnosis. 2018; 0(0) | | [Pubmed] | [DOI] | | | 43 |
What’s Important |
|
| Jack W. Crosland | | The Journal of Bone and Joint Surgery. 2018; 100(23): 2087 | | [Pubmed] | [DOI] | | | 44 |
Laboratory sample stability. Is it possible to define a consensus stability function? An example of five blood magnitudes |
|
| Rubén Gómez Rioja,Débora Martínez Espartosa,Marta Segovia,Mercedes Ibarz,María Antonia Llopis,Josep Miquel Bauça,Itziar Marzana,Nuria Barba,Monserrat Ventura,Isabel García del Pino,Juan José Puente,Andrea Caballero,Carolina Gómez,Ana García Álvarez,María Jesús Alsina,Virtudes Álvarez | | Clinical Chemistry and Laboratory Medicine (CCLM). 2018; 0(0) | | [Pubmed] | [DOI] | | | 45 |
Pseudohyperkalemia: in vitro phenomenon or misdiagnosis. A case report |
|
| K. Struniawski,S. Pogorzelski,D. Wróblewski,L. Kuzma,G. Kobus,S. Dobrzycki | | Progress in Health Sciences. 2018; 8(2): 239 | | [Pubmed] | [DOI] | | | 46 |
Chronic hyperkalemia in non-dialysis CKD: controversial issues in nephrology practice |
|
| Luca De Nicola,Luca Di Lullo,Ernesto Paoletti,Adamasco Cupisti,Stefano Bianchi | | Journal of Nephrology. 2018; | | [Pubmed] | [DOI] | | | 47 |
The effects of transport temperature and time on routine and specialized coagulation assays |
|
| Yeowon A. Kim,Kent B. Lewandrowski,Fils-Amie Lucien,Elizabeth M. Van Cott | | Blood Coagulation & Fibrinolysis. 2018; : 1 | | [Pubmed] | [DOI] | | | 48 |
Plasma potassium ranges associated with mortality across stages of chronic kidney disease: the Stockholm CREAtinine Measurements (SCREAM) project |
|
| Alessandro Gasparini,Marie Evans,Peter Barany,Hairong Xu,Tomas Jernberg,Johan Ärnlöv,Lars H Lund,Juan-Jesús Carrero | | Nephrology Dialysis Transplantation. 2018; | | [Pubmed] | [DOI] | | | 49 |
Variable Potassium Concentrations: Which Is Right and Which Is Wrong? |
|
| Talent Theparee,Robert C. Benirschke,Hong-Kee Lee | | Laboratory Medicine. 2017; | | [Pubmed] | [DOI] | | | 50 |
Drone Transport of Chemistry and Hematology Samples Over Long Distances |
|
| Timothy K Amukele,James Hernandez,Christine LH Snozek,Ryan G Wyatt,Matthew Douglas,Richard Amini,Jeff Street | | American Journal of Clinical Pathology. 2017; | | [Pubmed] | [DOI] | | | 51 |
Accuracy of bedside point of care testing in critical emergency department patients |
|
| Braden W. McIntosh,Jerina Vasek,Maria Taylor,Deborah Le Blanc,Henry C. Thode,Adam J. Singer | | The American Journal of Emergency Medicine. 2017; | | [Pubmed] | [DOI] | | | 52 |
Clotting time-dependent pseudohyperkalemia associated with Sézary syndrome |
|
| Hiroshi Umemura,Kouichi Itoshima,Ken Okada,Keiji Iwatsuki | | Clinica Chimica Acta. 2017; 470: 81 | | [Pubmed] | [DOI] | | | 53 |
Spurious Results in Mineral and Electrolyte Analysis |
|
| Elena Gorman | | Veterinary Clinics of North America: Small Animal Practice. 2017; 47(2): 263 | | [Pubmed] | [DOI] | | | 54 |
Noninvasive blood potassium measurement using signal-processed, single-lead ecg acquired from a handheld smartphone |
|
| Omar Z. Yasin,Zachi Attia,John J. Dillon,Christopher V. DeSimone,Yehu Sapir,Jennifer Dugan,Virend K. Somers,Michael J. Ackerman,Samuel J. Asirvatham,Christopher G. Scott,Kevin E. Bennet,Dorothy J. Ladewig,Dan Sadot,Amir B. Geva,Paul A. Friedman | | Journal of Electrocardiology. 2017; | | [Pubmed] | [DOI] | | | 55 |
Discrepant Potassium Results |
|
| Lu Song, Serge Alexanian, Scott W Binder | | The Journal of Applied Laboratory Medicine. 2017; 1(4): 432 | | [Pubmed] | [DOI] | | | 56 |
Pseudohyperkalemia in capillary whole-blood samples – an occasional error or a significant problem in a pediatric hospital? |
|
| Olga Ciepiela,Agata Raniszewska,Aneta Manda-Handzlik,Iwona Kotula,Urszula Demkow | | Clinical Chemistry and Laboratory Medicine (CCLM). 2017; 55(8) | | [Pubmed] | [DOI] | | | 57 |
Visual assessment of hemolysis affects patient safety |
|
| Ana Helena Luksic,Nora Nikolac Gabaj,Marijana Miler,Lora Dukic,Ana Bakliza,Ana-Maria Simundic | | Clinical Chemistry and Laboratory Medicine (CCLM). 2017; 0(0) | | [Pubmed] | [DOI] | | | 58 |
Pseudohyperkalaemia: a rare complication of splenectomy |
|
| R Wilson,RT Skelly | | The Annals of The Royal College of Surgeons of England. 2017; 99(2): e52 | | [Pubmed] | [DOI] | | | 59 |
Blood and Plasma Biochemistry Reference Intervals for Wild Juvenile American Alligators (Alligator mississippiensis) |
|
| Matthew T. Hamilton,Caitlin A. Kupar,Meghan D. Kelley,John W. Finger,Tracey D. Tuberville | | Journal of Wildlife Diseases. 2016; | | [Pubmed] | [DOI] | | | 60 |
Potassium measurement in the ED: interpret with caution |
|
| Gianfranco Cervellin,Giuseppe Lippi | | The American Journal of Emergency Medicine. 2016; | | [Pubmed] | [DOI] | | | 61 |
Potassium as a potential predictive biomarker of brain hypoxia in avalanche victims: preanalytical recommendations |
|
| Denis Monneret | | The American Journal of Emergency Medicine. 2016; | | [Pubmed] | [DOI] | | | 62 |
Findings of Phlebotomy Practices in Kenya in 2010: Need for Action |
|
| Daniel Kimani,Rachel Kamau,Renuka Gadde,Dejana Selenic,Stephen Maina,Lawrence Marum,Gao Hongjiang,Samuel Mwalili,Anthony Marfin,Jane Mwangi | | Journal of Infectious Diseases. 2016; 213(suppl 2): S53 | | [Pubmed] | [DOI] | | | 63 |
Microfluidic blood plasma separation for medical diagnostics: is it worth it? |
|
| W. S. Mielczarek,E. A. Obaje,T. T. Bachmann,M. Kersaudy-Kerhoas | | Lab Chip. 2016; | | [Pubmed] | [DOI] | | | 64 |
Na+, K+, Cl-, acid–base or H2O homeostasis in children with urinary tract infections: a narrative review |
|
| Anna Bertini,Gregorio P. Milani,Giacomo D. Simonetti,Emilio F. Fossali,Pietro B. Faré,Mario G. Bianchetti,Sebastiano A. G. Lava | | Pediatric Nephrology. 2015; | | [Pubmed] | [DOI] | | | 65 |
Kreislaufstillstand in besonderen Situationen |
|
| A. Truhlár,C.D. Deakin,J. Soar,G.E.A. Khalifa,A. Alfonzo,J.J.L.M. Bierens,G. Brattebø,H. Brugger,J. Dunning,S. Hunyadi-Anticevic,R.W. Koster,D.J. Lockey,C. Lott,P. Paal,G.D. Perkins,C. Sandroni,K.-C. Thies,D.A. Zideman,J.P. Nolan | | Notfall + Rettungsmedizin. 2015; 18(8): 833 | | [Pubmed] | [DOI] | | | 66 |
European Resuscitation Council Guidelines for Resuscitation 2015 |
|
| Anatolij Truhlár,Charles D. Deakin,Jasmeet Soar,Gamal Eldin Abbas Khalifa,Annette Alfonzo,Joost J.L.M. Bierens,Guttorm Brattebø,Hermann Brugger,Joel Dunning,Silvija Hunyadi-Anticevic,Rudolph W. Koster,David J. Lockey,Carsten Lott,Peter Paal,Gavin D. Perkins,Claudio Sandroni,Karl-Christian Thies,David A. Zideman,Jerry P. Nolan | | Resuscitation. 2015; 95: 148 | | [Pubmed] | [DOI] | | | 67 |
Reactive thrombocytosis and pseudohyperkalemia-entities we come across occasionally |
|
| R. Subha,Rachel Cherian Koshy | | Egyptian Journal of Anaesthesia. 2015; 31(3): 265 | | [Pubmed] | [DOI] | | | 68 |
Normal Potassium in the Presence of Gross Hemolysis |
|
| Mary M Barrett,Y Victoria Zhang | | Clinical Chemistry. 2015; 61(8): 1114 | | [Pubmed] | [DOI] | | | 69 |
A multidisciplinary approach to reducing spurious hyperkalemia in hospital outpatient clinics |
|
| Tze Ping Loh,Sunil K Sethi | | Journal of Clinical Nursing. 2015; 24(19-20): 2900 | | [Pubmed] | [DOI] | | | 70 |
How to reduce EDTA contamination in laboratory specimens: a Tunisian experience |
|
| Kahena Bouzid,Ahlem Bartkiz,Aymen Bouzainne,Samia Cherif,Saddem Ramdhani,Aida Zairi,Mehdi Mrad,Afef Bahlous,Jaouida Abdelmoula | | Clinical Chemistry and Laboratory Medicine (CCLM). 2015; 53(1) | | [Pubmed] | [DOI] | | | 71 |
Pseudohyperkalemia: A new twist on an old phenomenon |
|
| Qing H. Meng,Elizabeth A. Wagar | | Critical Reviews in Clinical Laboratory Sciences. 2014; : 1 | | [Pubmed] | [DOI] | | | 72 |
Do Hemolyzed Potassium Specimens Need to be Repeated? |
|
| Boris Khodorkovsky,Bartholomew Cambria,Martin Lesser,Barry Hahn | | The Journal of Emergency Medicine. 2014; 47(3): 313 | | [Pubmed] | [DOI] | |
|
 |
|
|
|
Search Pubmed for