Hyperkalemia or Not? A Diagnostic Pitfall in the Emergency Department
Introduction: Hyperkalemia, a potentially life-threatening electrolyte disturbance, is commonly encountered in the Emergency Department (ED). However, the frequency of factitious hyperkalemia, an artificially elevated potassium level in hyperkalemic ED patients, is unknown. This study aims to detect...
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| Format: | Article |
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eScholarship Publishing, University of California
2024-11-01
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| Series: | Western Journal of Emergency Medicine |
| Online Access: | https://escholarship.org/uc/item/01m613gh |
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| author | Frank-Peter Stephan Florian N. Riede Luca Ünlü Gioele Capoferri Tito Bosia Axel Regeniter Roland Bingisser Christian H. Nickel |
| author_facet | Frank-Peter Stephan Florian N. Riede Luca Ünlü Gioele Capoferri Tito Bosia Axel Regeniter Roland Bingisser Christian H. Nickel |
| author_sort | Frank-Peter Stephan |
| collection | DOAJ |
| description | Introduction: Hyperkalemia, a potentially life-threatening electrolyte disturbance, is commonly encountered in the Emergency Department (ED). However, the frequency of factitious hyperkalemia, an artificially elevated potassium level in hyperkalemic ED patients, is unknown. This study aims to detect the rate of factitious hyperkalemia among patients with a potassium concentration of ≥5.0 mmol/l in an all-comer ED population. Methods: This retrospective, monocentric chart review analyzed data of 2,440 ED patients who presented with a potassium concentration of ≥5.0 mmol/L in their initial whole blood or plasma sample, who also underwent a repeat potassium measurement on the same day. Two groups were established based on potassium levels in the initial and repeat blood tests: 1) True hyperkalemia, characterized by consistently elevated potassium levels in both the initial and repeat samples; and 2) Factitious hyperkalemia, defined by an elevated initial potassium level while the repeat blood test showed a normal potassium level. A subset of factitious hyperkalemia was spurious hyperkalemia. In spurious hyperkalemia, the initial blood sample showed an elevated potassium level with evidence of hemolysis, but a repeat test revealed a normal potassium level without evidence of hemolysis. Results: Of the 2,440 patients, 1,576 (65%) had true hyperkalemia and 864 (35%) factitious hyperkalemia. Among the 864 patients with factitious hyperkalemia, 597 (69%) displayed hemolysis in their initial blood sample, indicating spurious hyperkalemia due to in-vitro hemolysis. Conclusion: These data show that about one third of all hyperkalemic blood samples drawn in the ED were due to factitious hyperkalemia. The leading cause of factitious hyperkalemia was spurious hyperkalemia due to in-vitro hemolysis. |
| format | Article |
| id | doaj-art-7e1bb7d4b7bd4e6a8832db4b655b20f7 |
| institution | Kabale University |
| issn | 1936-900X 1936-9018 |
| language | English |
| publishDate | 2024-11-01 |
| publisher | eScholarship Publishing, University of California |
| record_format | Article |
| series | Western Journal of Emergency Medicine |
| spelling | doaj-art-7e1bb7d4b7bd4e6a8832db4b655b20f72025-02-07T16:29:05ZengeScholarship Publishing, University of CaliforniaWestern Journal of Emergency Medicine1936-900X1936-90182024-11-0126117617910.5811/westjem.3528635286Hyperkalemia or Not? A Diagnostic Pitfall in the Emergency DepartmentFrank-Peter Stephan0Florian N. Riede1Luca Ünlü2Gioele Capoferri3Tito Bosia4Axel Regeniter5Roland Bingisser6Christian H. Nickel7Bürgerspital Solothurn, Department of Cardiology, Solothurn, Solothurn, SwitzerlandKantonsspital Aarau, Department of Cardiology, Aarau, Aarau, SwitzerlandUniversity Hospital Basel, Emergency Department, Basel, Basel Stadt, SwitzerlandUniversity Hospital Basel, Emergency Department, Basel, Basel Stadt, SwitzerlandLe Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Lausanne, SwitzerlandMEDICA Medical Laboratories, Zürich, Zürich, SwitzerlandUniversity Hospital Basel, Emergency Department, Basel, Basel Stadt, SwitzerlandUniversity Hospital Basel, Emergency Department, Basel, Basel Stadt, SwitzerlandIntroduction: Hyperkalemia, a potentially life-threatening electrolyte disturbance, is commonly encountered in the Emergency Department (ED). However, the frequency of factitious hyperkalemia, an artificially elevated potassium level in hyperkalemic ED patients, is unknown. This study aims to detect the rate of factitious hyperkalemia among patients with a potassium concentration of ≥5.0 mmol/l in an all-comer ED population. Methods: This retrospective, monocentric chart review analyzed data of 2,440 ED patients who presented with a potassium concentration of ≥5.0 mmol/L in their initial whole blood or plasma sample, who also underwent a repeat potassium measurement on the same day. Two groups were established based on potassium levels in the initial and repeat blood tests: 1) True hyperkalemia, characterized by consistently elevated potassium levels in both the initial and repeat samples; and 2) Factitious hyperkalemia, defined by an elevated initial potassium level while the repeat blood test showed a normal potassium level. A subset of factitious hyperkalemia was spurious hyperkalemia. In spurious hyperkalemia, the initial blood sample showed an elevated potassium level with evidence of hemolysis, but a repeat test revealed a normal potassium level without evidence of hemolysis. Results: Of the 2,440 patients, 1,576 (65%) had true hyperkalemia and 864 (35%) factitious hyperkalemia. Among the 864 patients with factitious hyperkalemia, 597 (69%) displayed hemolysis in their initial blood sample, indicating spurious hyperkalemia due to in-vitro hemolysis. Conclusion: These data show that about one third of all hyperkalemic blood samples drawn in the ED were due to factitious hyperkalemia. The leading cause of factitious hyperkalemia was spurious hyperkalemia due to in-vitro hemolysis.https://escholarship.org/uc/item/01m613gh |
| spellingShingle | Frank-Peter Stephan Florian N. Riede Luca Ünlü Gioele Capoferri Tito Bosia Axel Regeniter Roland Bingisser Christian H. Nickel Hyperkalemia or Not? A Diagnostic Pitfall in the Emergency Department Western Journal of Emergency Medicine |
| title | Hyperkalemia or Not? A Diagnostic Pitfall in the Emergency Department |
| title_full | Hyperkalemia or Not? A Diagnostic Pitfall in the Emergency Department |
| title_fullStr | Hyperkalemia or Not? A Diagnostic Pitfall in the Emergency Department |
| title_full_unstemmed | Hyperkalemia or Not? A Diagnostic Pitfall in the Emergency Department |
| title_short | Hyperkalemia or Not? A Diagnostic Pitfall in the Emergency Department |
| title_sort | hyperkalemia or not a diagnostic pitfall in the emergency department |
| url | https://escholarship.org/uc/item/01m613gh |
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