严重白细胞增多症伴高钾血症：是否需要治疗？
Hyperkalemia in the setting of severe leukocytosis: Should you treat?
机构信息
Department of Internal Medicine, The University of Texas MD Anderson Cancer Center, USA.
Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, USA.
出版信息
Am J Emerg Med. 2023 Apr;66:174.e1-174.e2. doi: 10.1016/j.ajem.2023.01.008. Epub 2023 Jan 7.
BACKGROUND
Severe hyperkalemia is a common and life-threatening problem presenting to the emergency department. Rapid correction of the electrolyte abnormality is essential but doing so can be detrimental in circumstances under which delaying treatment for confirmation is required. Our case exemplifies one of those scenarios: pseudohyperkalemia in the setting of severe leukocytosis.
CASE
An elderly woman with long-standing but untreated chronic lymphocytic leukemia presented with a left hip fracture. She was found to have a potassium level of 8.4 mEq/L without symptoms of hyperkalemia, renal disease, or EKG findings. Her white blood cell count was 444 K/uL. Despite a potentially life-threatening hyperkalemia, correction was deferred pending confirmation by venous whole blood, which revealed a normal potassium level.
DISCUSSION
Pseudohyperkalemia can occur in the setting of severe leukocytosis. It is important for emergency physicians to recognize this phenomenon and avoid iatrogenic hypokalemia. The pathophysiology behind this phenomenon and the methods for correct analysis are presented here.
背景
严重高钾血症是急诊科常见且危及生命的问题。纠正电解质异常至关重要，但在需要延迟治疗以确认的情况下，这样做可能会造成损害。我们的病例就是其中一种情况：严重白细胞增多症时的假性高钾血症。
病例
一位患有长期未经治疗的慢性淋巴细胞白血病的老年女性因左侧髋部骨折就诊。她的血钾水平为 8.4 mEq/L，没有高钾血症、肾脏疾病或心电图发现的症状。她的白细胞计数为 444 K/uL。尽管存在潜在危及生命的高钾血症，但在通过静脉全血确认之前，延迟了纠正，结果显示血钾水平正常。
讨论
严重白细胞增多症时可能会出现假性高钾血症。急诊医生识别这种现象并避免医源性低钾血症非常重要。本文介绍了这种现象的病理生理学及正确分析方法。
Zotero 插件