Johnson C M, Hughes K M
Department of Trauma Services, Conemaugh's Memorial Medical Center, Johnstown, Pennsylvania, USA.
Am Surg. 2001 Feb;67(2):168-70.
Hyperkalemia is a regularly encountered electrolyte abnormality. Less commonly recognized is pseudohyperkalemia. In vitro clotting results in the release of potassium from the formed elements of blood; this falsely elevates the serum potassium concentration. Usually attributed to thrombocytosis, leukocytosis, or hemolysis it is rarely reported in the postsplenectomy trauma patient. A 49-year-old man underwent splenectomy for a grade IV splenic injury. He developed an elevated serum potassium on postoperative day 16. His renal function remained normal, and an active search for causes of hyperkalemia failed to delineate a source for his elevated potassium. Pseudohyperkalemia was proposed as an etiology and confirmed by analyzing simultaneous serum (5.9 mEq/L) and plasma potassium levels (3.9 mEq/L). The serum potassium showed a concomitant rise with the evolution of the patient's postsplenectomy thrombocytosis. This is a case report of our patient and a literature review of this rarely reported and underestimated cause of a potentially serious electrolyte abnormality. We found through our patient that pseudohyperkalemia does occur in the postsplenectomy population and that this should be included in the differential diagnosis of any patient with an elevated serum potassium level and thrombocytosis.
高钾血症是一种常见的电解质异常。较少被认识到的是假性高钾血症。体外凝血会导致血液有形成分释放钾；这会错误地升高血清钾浓度。通常归因于血小板增多症、白细胞增多症或溶血，在脾切除术后创伤患者中很少有报道。一名49岁男性因IV级脾损伤接受了脾切除术。他在术后第16天出现血清钾升高。他的肾功能保持正常，积极寻找高钾血症的病因未能确定其钾升高的来源。假性高钾血症被提出作为病因，并通过分析同时测定的血清钾水平（5.9 mEq/L）和血浆钾水平（3.9 mEq/L）得到证实。血清钾随着患者脾切除术后血小板增多症的发展而同步升高。这是关于我们患者的病例报告以及对这种很少被报道且被低估的潜在严重电解质异常病因的文献综述。通过我们的患者发现，假性高钾血症确实会发生在脾切除术后人群中，并且在任何血清钾水平升高且有血小板增多症的患者的鉴别诊断中都应考虑到这一点。
