Neupane Sanjay Prakash, Sharma Pratibha, Dangal Mahesh Mani
Internal Medicine, PeaceHealth Southwest Medical Center, 400 NE Mother Joseph Place, Vancouver, WA 98664, USA.
Maimonides Medical Center, 4802 10th Avenue, Brooklyn, NY 11219, USA.
Case Rep Med. 2018 Jul 24;2018:9060892. doi: 10.1155/2018/9060892. eCollection 2018.
Hyperkalemia is a commonly encountered clinical problem. Pseudohyperkalemia is believed to be an in vitro phenomenon that does not reflect in vivo serum potassium and therefore should not be treated. Here, we present a case who unfortunately underwent unnecessary treatment because of failure to detect the common lab abnormality of pseudohyperkalemia.
A 91-year-old female with a history of chronic lymphocytic leukemia presented to the emergency with nausea and vomiting 24 hours after her first chemotherapy with chlorambucil. Physical examination was overall unremarkable. She had a leukocytosis of 210 × 10/L with 96% lymphocytes along with chronic anemia with hemoglobin of 8.1 g/dL. Her initial sodium and potassium levels were normal. During the clinical course, her potassium progressively worsened and failed to improve despite standard medical treatment. Patient ultimately underwent dialysis.
Differentiating true hyperkalemia from pseudohyperkalemia is very important in selected group of patients to avoid unnecessary medications, higher level of care, and unnecessary procedure including dialysis. We want to emphasize the importance of simple yet profound knowledge of technique of blood draws and basic metabolic panel processing for every clinician in day-to-day practice.
高钾血症是一个常见的临床问题。假性高钾血症被认为是一种体外现象，并不反映体内血清钾水平，因此不应进行治疗。在此，我们报告一例因未能检测到假性高钾血症这一常见实验室异常而不幸接受了不必要治疗的病例。
一名91岁女性，有慢性淋巴细胞白血病病史，在首次使用苯丁酸氮芥化疗24小时后因恶心、呕吐就诊于急诊科。体格检查总体无异常。她白细胞计数为210×10⁹/L，淋巴细胞占96%，伴有慢性贫血，血红蛋白为8.1g/dL。她最初的钠和钾水平正常。在临床过程中，她的钾水平逐渐恶化，尽管进行了标准药物治疗仍未改善。患者最终接受了透析。
在特定患者群体中，区分真性高钾血症和假性高钾血症非常重要，以避免不必要的药物治疗、更高水平的护理以及包括透析在内的不必要操作。我们想强调，对于每位临床医生在日常实践中，掌握简单而深入的采血技术和基本代谢指标处理知识的重要性。
