Onuigbo Macaulay Amechi, Tan Heng, Sherman Sarah E
The Robert Larner, M.D. College of Medicine, University of Vermont, Burlington, Vermont, USA.
Rambam Maimonides Med J. 2021 Apr 29;12(2):e0018. doi: 10.5041/RMMJ.10439.
Sickle cell disease (SCD) predisposes the patient to recurrent episodes of acute painful hemolytic crisis. Sickle cell nephropathy (SCN) is not uncommon in adult patients, and renal manifestations of SCN include renal ischemia, microinfarcts, renal papillary necrosis, and renal tubular abnormalities with variable clinical presentations. Intravascular hemolysis and reduced glomerular filtration rate with renal tubular dysfunction predispose to true hyperkalemia. Hemolytic crisis can be complicated by sepsis, leading to significant degrees of thrombocytosis, and thrombocytosis is a well-defined cause of pseudohyperkalemia. We describe a 40-year-old African American male patient with sickle cell anemia who exhibited alternating episodes of true hyperkalemia and pseudohyperkalemia, during consecutive hospital admissions. Clearly, true hyperkalemia is a potentially lethal condition. At the same time, the institution of inappropriate and intensive treatment of pseudohyperkalemia leading to severe hypokalemia is also potentially lethal. The need for this caution is most imperative with the recent introduction of the safer and more potent potassium binders, patiromer and sodium zirconium cyclosilicate.
镰状细胞病（SCD）使患者易反复发生急性疼痛性溶血危机。镰状细胞肾病（SCN）在成年患者中并不罕见，SCN的肾脏表现包括肾缺血、微梗死、肾乳头坏死以及临床表现各异的肾小管异常。血管内溶血和肾小球滤过率降低伴肾小管功能障碍易导致真性高钾血症。溶血危机会因败血症而复杂化，导致显著程度的血小板增多，而血小板增多是假性高钾血症的一个明确病因。我们描述了一名40岁患有镰状细胞贫血的非裔美国男性患者，在连续住院期间出现了真性高钾血症和假性高钾血症交替发作的情况。显然，真性高钾血症是一种潜在的致命状况。与此同时，对假性高钾血症进行不恰当且强化的治疗导致严重低钾血症也同样具有潜在致命性。随着最近更安全、更有效的钾结合剂帕替罗姆和环硅酸锆钠的引入，这种谨慎的必要性变得最为迫切。
