Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login 
Visit old site
Home Print this page Email this page Small font size Default font size Increase font size
Users Online: 185


 
 Table of Contents  
REVIEW ARTICLE
Year : 2013  |  Volume : 5  |  Issue : 4  |  Page : 255-259

Errors in potassium measurement: A laboratory perspective for the clinician


1 Department of Pathology, Hofstra North Shore-Long Island Jewish School of Medicine, New York, USA
2 Saint Peter's University Hospital/Drexel University School of Medicine, New Brunswick, USA

Date of Web Publication11-Apr-2013

Correspondence Address:
Jaya R Asirvatham
6 Ohio Drive, Ste 202, Lake Success 11040, New York
USA
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1947-2714.110426

Rights and Permissions
  Abstract 

Errors in potassium measurement can cause pseudohyperkalemia, where serum potassium is falsely elevated. Usually, these are recognized either by the laboratory or the clinician. However, the same factors that cause pseudohyperkalemia can mask hypokalemia by pushing measured values into the reference interval. These cases require a high-index of suspicion by the clinician as they cannot be easily identified in the laboratory. This article discusses the causes and mechanisms of spuriously elevated potassium, and current recommendations to minimize those factors. "Reverse" pseudohyperkalemia and the role of correction factors are also discussed. Relevant articles were identified by a literature search performed on PubMed using the terms "pseudohyperkalemia," "reverse pseudohyperkalemia," "factitious hyperkalemia," "spurious hyperkalemia," and "masked hypokalemia."

Keywords: Factitious hyperkalemia, Hemolysis, Potassium, Pseudohyperkalemia, Reverse pseudohyperkalemia, Spurious hyperkalemia


How to cite this article:
Asirvatham JR, Moses V, Bjornson L. Errors in potassium measurement: A laboratory perspective for the clinician. North Am J Med Sci 2013;5:255-9

How to cite this URL:
Asirvatham JR, Moses V, Bjornson L. Errors in potassium measurement: A laboratory perspective for the clinician. North Am J Med Sci [serial online] 2013 [cited 2017 Apr 27];5:255-9. Available from: http://www.najms.org/text.asp?2013/5/4/255/110426


  Introduction Top


It has been estimated that 60-70% of clinical decisions are based on laboratory results and potassium is among the ten most commonly tested analytes. [1] About 4-32% of all laboratory errors occur during the analytical phase of testing the sample. The majority of errors (32-75%) occur before the sample is analyzed: During labeling, collection, transport or centrifugation. [2] The rest of the errors occur during report generation or interpretation. This article discusses the causes and mechanisms of spuriously elevated potassium, and current recommendations to minimize those factors. Masked hypokalemia, reverse pseudohyperkalemia and the role of correction factors are also discussed.


  Measurement of Potassium Top


Potassium is usually measured using an Ion-selective electrode (ISE), which converts the activity (or effective concentration) of the ion dissolved in solution into an electric potential measured by a voltmeter. Both plasma and serum can be used to measure potassium. Samples can be collected in plain silicone coated glass/plastic tubes, gel separator tubes with or without clot activator for serum estimations (with thrombin-based clot activator for stat estimations) or in tubes containing lithium/sodium/ammonium heparin as an anticoagulant for plasma estimations with or without gel separator. Platelets release potassium during the clotting process, resulting in higher (0.36 ± 0.18 mmol/L) potassium concentrations in the serum as compared to plasma. [3] Pseudohyperkalemia is suspected when the laboratory value of the measured potassium is high but the patient does not manifest signs of hyperkalemia such as abnormal electrocardiogram. Some authors have tried to define pseudohyperkalemia as a difference between serum and plasma potassium concentrations of more than 0.4 mmol/L when samples remain at room temperature and are tested within an hour of collection. [4] The source of potassium is usually cells but can be contaminants. Since 98% of body potassium is intracellular, a small release of potassium can significantly affect the concentration of measured (extracellular) potassium. The ratio between intracellular and extracellular potassium is approximately 40:1 and a change in the ratio as small as 2.5% will increase the potassium concentration by 0.1 mEq/L. [5] Constituents of blood (red blood cells [RBC], white blood cells [WBC], platelets) and skeletal muscle release intracellular potassium either due to faulty collection techniques or disease states. The most common cause of cellular release is cell lysis, which can involve RBC (hemolysis), WBC (leukocytolysis), platelets (thrombocytolysis) or all the three (pancytolysis).


  Causes of Pseudohyperkalemia Top


Mechanical factors

A tourniquet applied for prolonged periods of more than 1 min causes hemo concentration, altered water balance and hemolysis. Fist clenching is not recommended as it causes local release of potassium from the forearm muscle and increased blood flow. [6],[7],[8] In one study, the measured potassium in the pumping hand was 1.04 mmol/L higher compared to a simultaneously measured non-pumping hand. [6] Traumatic venipuncture or probing, inappropriate needle diameter, excessive force with syringe draws either during aspiration or transfer, increased turbulence due to diameter mismatch of catheter, tube adapter device and needle can all result in hemolysis and pseudohyperkalemia. [2],[6] Cases of pseudohyperkalemia due to pneumatic tube transport/unpadded canisters have been reported, especially in disease states with fragile cell membranes such as leukemia. [9],[10] Mechanical force during specimen processing such as vigorous mixing, excessive centrifugal force, prolonged fixed angle centrifugation or re-centrifugation of gel separator tubes also need to be considered. [2],[6]

Chemical factors

If ethanol containing antiseptics are not allowed to dry completely before venipuncture, the solution can enter the blood stream and disrupt cell membranes. [2]

Temperature

Cold temperature inhibits the sodium potassium pump resulting in leakage of potassium. Higher temperatures initially decrease and then increase potassium concentrations, probably related to increased usage and exhaustion of glucose that generates adenosine triphosphate (ATP) for the sodium-potassium pump. Recommended temperature for specimen storage prior to testing is 15-25°C. [2] Specimens should not be stored between 2°C and 8°C, or above room temperature for more than 24 h. [2] Elevations in potassium more commonly observed in samples from doctors' offices compared to inpatient or laboratory collections, attributed to changes in temperature that the sample is exposed to during transport in winter, have been dubbed "Seasonal Pseudohyperkalemia." [11],[12]

Time

Delayed processing, results in exhaustion of available glucose to generate ATP. Since ATP fuels the sodium potassium pump and maintains the gradient across the cell membrane, failure of the pump results in leakage of potassium out of the cell, resulting in pseudohyperkalemia.

Patient factors

Fear of imminent venipuncture or crying associated with hyperventilation (even for 3-6 min) is associated with acute respiratory alkalosis, which results in a significant hyperkalemic response mediated by enhanced alpha-adrenergic activity. Though the exact cellular mechanism is not known, animal models suggest a role for alpha receptor mediated activation of hepatic calcium dependent potassium channels. [13]

Thrombocytosis results in increased release of potassium during the clotting process. Sevatos, et al. examined platelet count and release of potassium during the clotting process and found an average increase of 0.82 mmol/L (range of platelet count: 400-1500 × 10 3 /mm 3 ). However, the increase was not proportional: There was an initial linear increase at higher levels of platelets followed by a drop, presumably caused by re-entry of potassium into RBC to maintain homeostasis. [14] The increase was more profound in thrombocytosis and mixed RBC disorders compared to pure erythrocytosis. Factitious hyperkalemia may be seen in WBC neoplasms due to increased membrane fragility and little reserve capacity for withstanding mechanical agitation or by leakage into the serum. [10] It is suspected that neoplastic WBC membranes (e.g., chronic lymphocytic leukemia) are more likely to be leaky or to be disrupted during pneumatic chute transport. Another factor is that at high-levels of leukocytosis, there is increased consumption (and thereby exhaustion) of metabolites that fuel the ATP pump.

As the spleen is a major reserve for platelets, post-splenectomy status has also been reported to be associated with pseudohyperkalemia. [15],[16] In patients with chronic renal failure, pseudohyperkalemia due to co-existing myeloproliferative neoplasm was identified only when therapy failed to reduce potassium concentration. [17],[18]

Familial pseudohyperkalemia is an autosomal dominant disorder characterized by abnormal passive outward leakage of potassium across the RBC membrane. It is an in-vitro phenomenon, occurring when blood is stored at room temperature. [19],[20]

Contaminants

Potassium containing IV fluids are common contaminants as are potassium salts of tube additives. If the recommended order of draw during phlebotomy is not maintained, carryover and back flow of potassium salts of tube additives such as ethylenediamine tetra-acetic acid (EDTA) or oxalate can elevate measured potassium. The recommended (simplified) order of draw is: Culture tubes followed by sodium citrate tubes, serum tubes (with or without clot activator/gel separator), heparin tubes, EDTA tubes, and sodium fluoride tubes.

Povidone iodine in one study has been associated with increase in measured potassium up to 1 mmol/L, the mechanism of which is unknown. [21] Contaminants can also interfere with the ion-selective electrode that measures potassium. For example, Benzalkonium heparin, a chemical used to coat catheters in IV-access devices to decrease thrombus formation and infections, interfered with electrodes in an older generation of instruments that measured potassium indirectly using a diluted sample. [22],[23]

Miscellaneous causes

Using plasma reference ranges to interpret serum values could result in pseudohyperkalemia. Mislabeling of patient samples should be excluded.


  Reverse Pseudohyperkalemia Top


Reverse pseudohyperkalemia is when plasma potassium is falsely high but the serum potassium is normal. [24],[25],[26] This phenomenon has been reported in samples of patients with leukemia/lymphoma. In one study, the plasma potassium concentration of a sample collected in a lithium heparin tube was 6.0 mmol/L higher than simultaneously measured serum potassium concentration. [26] The degree of increase in potassium was directly related to the amount of heparin. Potassium measured using a heparin coated syringe which contains about one-third the amount of heparin in a tube, did not cause an increase in plasma potassium. There was no evidence of hemolysis, suggesting a non-RBC source of potassium. It is postulated that neoplastic WBC membranes are especially sensitive to disruption by heparin, the anticoagulant used for plasma estimations. High values of potassium and lactate dehydrogenase (LDH) in the absence of hemolysis might indicate in-vitro lysis of WBC.


  Masked Hypokalemia Top


The same factors that cause pseudohyperkalemia can mask hypokalemia by pushing the measured potassium of a hypokalemic patient into the reference interval. These cases are not easily identified as they require a high index of suspicion by the clinician. [4],[27] In one study, more than a third of hypokalemic cases were missed due to hemolysis when using whole blood to estimate potassium. [28] Re-evaluation of cases of suspected hypokalemia with serum/plasma concentrations of potassium within the reference range might be indicated especially, in the setting of a high Hemolysis Index (HI). The HI is a semi-quantitative measurement of the concentration of free hemoglobin in mg/dL.


  Correction Factors Top


Several researchers have attempted to quantify potassium release during hemolysis using indices such as the serum or plasma free hemoglobin concentration, -I), Mean Corpuscular Hemoglobin Concentration (MCHC) or HI multiplied by a constant (e.g., Corrected K + = Measured K + -(HI × 0.004). Though some have found a linear relationship between potassium elevation and degree of hemolysis, others have not. [29],[30],[31],[32],[33],[34],[35],[36] Correction factors for platelet counts have also been proposed. [37] A quantitative corrected potassium result may be unreliable as pseudohyperkalemia can be caused by the interplay of several factors that may not be measurable. However, these correction factors might have a role in estimating the likelihood of potassium being low, high or within the reference interval, in the interest of patient care, where a repeat sample would be difficult, if not impossible to obtain. [28]


  Whole Blood Testing Top


The need for rapid accurate assessment of potassium in critically ill patients where the expected turnaround time is in the order of a few minutes has led to the use of blood gas analyzers and point of care testing using whole blood. Investigators have analyzed the interchangeability of electrolytes measured with point of care, blood gas, and central laboratory analyzers. Some have found stat measurements using whole blood to be comparable to laboratory analyzers using serum/plasma. [38],[39]

Interestingly Chacko, et al. [40] found that while agreement between whole blood and serum was good, differences were large and clinically significant at concentrations below 3 mmol/L (whole blood measurements were up to 1 mmol/L lower compared to serum). The authors had used plastic lithium coated ABG syringes (DRIHEP A-LINE arterial blood gas collection syringe, 3.0 mL volume, 1.6 mL recommended draw Becton Dickinson Diagnostics® , Plymouth, UK) for blood gas analysis to minimize the effect of heparin flushes and also determined that their pneumatic system did not significantly alter the electrolyte values. The authors proposed electrode differences as one of the probable causes for the difference: Direct ISE (GEM 3000® ABG analyzer) for on-site assessment compared to indirect ISE in central laboratory analyzers (Olympus AU2700 discrete chemistry analyzer, Olympus Optical Company, Ltd., Japan) which can be affected by dissolved solids such as proteins. The authors caution against over/underestimating therapeutic effect when comparing potassium concentrations from two different sample types/analyzers.

In another study, Hawkins, et al. [28] demonstrated that over 33% of hypokalemic cases were missed when using whole blood to determine potassium concentration. Moreover, hand disinfectants have been shown to significantly elevate potassium concentration especially when direct ion selective electrodes were used in point of care testing of whole blood samples.


  Conclusion Top


There are several factors which singly or in combination can contribute to a spurious elevation of measured potassium or mask hypokalemia by pushing the measured potassium into the reference interval. Potassium is predominantly intracellular; hence small shifts can cause large changes in the measured value. Efforts must be made to minimize these factors. In addition, clinicians must have a high-index of suspicion when the measured potassium is sharply discordant from prior readings, or when the laboratory values are not concordant with the clinical picture. If pseudohyperkalemia is suspected, the laboratory should be consulted, so that appropriate samples can be submitted and investigations performed.

 
  References Top

1.Forsman RW. Why is the laboratory an afterthought for managed care organizations? Clin Chem 1996;42:813-6.  Back to cited text no. 1
    
2.Stankovic AK, Smith S. Elevated serum potassium values: The role of preanalytic variables. Am J Clin Pathol 2004;121:S105-12.  Back to cited text no. 2
    
3.Nijsten MW, de Smet BJ, Dofferhoff AS. Pseudohyperkalemia and platelet counts. N Engl J Med 1991;325:1107.  Back to cited text no. 3
    
4.Sevastos N, Theodossiades G, Archimandritis AJ. Pseudohyperkalemia in serum: A new insight into an old phenomenon. Clin Med Res 2008;6:30-2.  Back to cited text no. 4
    
5.Serum Potassium-Clinical Methods-NCBI Bookshelf, Rastegar A. Serum Potassium. In: Walker HK, Hall WD, Hurst JW, editors. Clinical Methods: The History, Physical, and Laboratory Examinations. 3 rd ed. Chapter 195. Boston: Butterworths; 1990.  Back to cited text no. 5
    
6.Baer DM, Ernst DJ, Willeford SI, Gambino R. Investigating elevated potassium values. MLO Med Lab Obs 2006;38:24, 26, 30-1.  Back to cited text no. 6
    
7.Bailey IR, Thurlow VR. Is suboptimal phlebotomy technique impacting on potassium results for primary care? Ann Clin Biochem 2008;45:266-9.  Back to cited text no. 7
    
8.Saleem S, Mani V, Chadwick MA, Creanor S, Ayling RM. A prospective study of causes of haemolysis during venepuncture: Tourniquet time should be kept to a minimum. Ann Clin Biochem 2009;46:244-6.  Back to cited text no. 8
    
9.Guiheneuf R, Vuillaume I, Mangalaboyi J, Launay D, Berthon C, Maury JC, et al. Pneumatic transport is critical for leukaemic patients with major leukocytosis: What precautions to measure lactate dehydrogenase, potassium and aspartate aminotransferase? Ann Clin Biochem 2010;47:94-6.  Back to cited text no. 9
    
10.Kellerman PS, Thornbery JM. Pseudohyperkalemia due to pneumatic tube transport in a leukemic patient. Am J Kidney Dis 2005;46:746-8.  Back to cited text no. 10
    
11.Sinclair D, Briston P, Young R, Pepin N. Seasonal pseudohyperkalaemia. J Clin Pathol 2003;56:385-8.  Back to cited text no. 11
    
12.Turner HE, Peake RW, Allison JJ. Seasonal pseudohyperkalaemia: No longer an issue? Ann Clin Biochem 2012;49:94-6.  Back to cited text no. 12
    
13.Krapf R, Caduff P, Wagdi P, Stäubli M, Hulter HN. Plasma potassium response to acute respiratory alkalosis. Kidney Int 1995;47:217-24.  Back to cited text no. 13
    
14.Sevastos N, Theodossiades G, Efstathiou S, Papatheodoridis GV, Manesis E, Archimandritis AJ. Pseudohyperkalemia in serum: The phenomenon and its clinical magnitude. J Lab Clin Med 2006;147:139-44.  Back to cited text no. 14
    
15.Ahmed R, Isaac AM. Postsplenectomy thrombocytosis and pseudohyperkalemia in trauma: A case report and review of literature. J Trauma 2009;67:E17-9.  Back to cited text no. 15
    
16.Lambertucci JR, Otoni A, Rodrigues VL. Pseudohyperkalemia and pseudohyperphosphatemia after splenectomy in hepatosplenic schistosomiasis mansoni. Rev Soc Bras Med Trop 2008;41:692.  Back to cited text no. 16
    
17.Fukasawa H, Furuya R, Kato A, Yonemura K, Fujigaki Y, Yamamoto T, et al. Pseudohyperkalemia occurring in a patient with chronic renal failure and polycythemia vera without severe leukocytosis or thrombocytosis. Clin Nephrol 2002;58:451-4.  Back to cited text no. 17
    
18.Ifudu O, Markell MS, Friedman EA. Unrecognized pseudohyperkalemia as a cause of elevated potassium in patients with renal disease. Am J Nephrol 1992;12:102-4.  Back to cited text no. 18
    
19.Sugimoto T, Kume S, Osawa N, Nakazawa J, Koya D, Kashiwagi A. Familial pseudohyperkalemia: A rare cause of hyperkalemia. Intern Med 2005;44:875-8.  Back to cited text no. 19
    
20.Kitamura K, Tomita K. Familial pseudohyperkalemia: A rare syndrome, but diverse genetic heterogeneity. Intern Med 2005;44:781-2.  Back to cited text no. 20
    
21.Van Steirteghem AC, Young DS. Povidone-iodine ("Betadine") disinfectant as a source of error. Clin Chem 1977;23:1512.  Back to cited text no. 21
    
22.Koch TR, Cook JD. Benzalkonium interference with test methods for potassium and sodium. Clin Chem 1990;36:807-8.  Back to cited text no. 22
    
23.Gaylord MS, Pittman PA, Bartness J, Tuinman AA, Lorch V. Release of benzalkonium chloride from a heparin-bonded umbilical catheter with resultant factitious hypernatremia and hyperkalemia. Pediatrics 1991;87:631-5.  Back to cited text no. 23
    
24.Garwicz D, Karlman M. Early recognition of reverse pseudohyperkalemia in heparin plasma samples during leukemic hyperleukocytosis can prevent iatrogenic hypokalemia. Clin Biochem 2012;45:1700-2.  Back to cited text no. 24
    
25.Garwicz D, Karlman M, Øra I. Reverse pseudohyperkalemia in heparin plasma samples from a child with T cell acute lymphoblastic leukemia with hyperleukocytosis. Clin Chim Acta 2011;412:396-7.  Back to cited text no. 25
    
26.Meng QH, Krahn J. Reverse pseudohyperkalemia in heparin plasma samples from a patient with chronic lymphocytic leukemia. Clin Biochem 2011;44:728-30.  Back to cited text no. 26
    
27.Gambino R, Sanfilippo M, Lazcano L. Pseudohyperkalaemia from finger flexion during venepuncture masks true hypokalaemia. Ann Clin Biochem 2009;46:177. Hawkins R. Measurement of whole-blood potassium: Is it clinically safe? Clin Chem 2003;49:2105-6.  Back to cited text no. 27
    
28.Dimeski G, Clague AE, Hickman PE. Correction and reporting of potassium results in haemolysed samples. Ann Clin Biochem 2005;42:119-23.  Back to cited text no. 28
    
29.Owens H, Siparsky G, Bajaj L, Hampers LC. Correction of factitious hyperkalemia in hemolyzed specimens. Am J Emerg Med 2005;23:872-5.  Back to cited text no. 29
    
30.Jeffery J, Sharma A, Ayling RM. Detection of haemolysis and reporting of potassium results in samples from neonates. Ann Clin Biochem 2009;46:222-5.  Back to cited text no. 30
    
31.Mansour MM, Azzazy HM, Kazmierczak SC. Correction factors for estimating potassium concentrations in samples with in vitro hemolysis: A detriment to patient safety. Arch Pathol Lab Med 2009;133:960-6.  Back to cited text no. 31
    
32.Hishiki K, Toyama M, Sato R, Suzuki I, Kisugi R, Koike M, et al. Draft proposal to estimate true values of serum potassium in samples from patients with myeloproliferative neoplasma. Rinsho Byori 2012;60:516-22.  Back to cited text no. 32
    
33.Brescia V, Tampoia M, Mileti A. Evaluation of factitious hyperkalemia in hemolytic samples: Impact of the mean corpuscular hemoglobin concentration. Lab Med 2009;40:224-6.  Back to cited text no. 33
    
34.Hawkins R. Variability in potassium/hemoglobin ratios for hemolysis correction. Clin Chem 2002;48:796.  Back to cited text no. 34
    
35.Shepherd J, Warner MH, Poon P, Kilpatrick ES. Use of haemolysis index to estimate potassium concentration in in-vitro haemolysed serum samples. Clin Chem Lab Med 2006;44:877-9.  Back to cited text no. 35
    
36.Kim HJ, Chung CH, Moon CO, Park CG, Hong SP, Oh MS, et al. Determinants of magnitude of pseudohyperkalemia in thrombocytosis. Korean J Intern Med 1990;5:97-100.  Back to cited text no. 36
    
37.Leino A, Kurvinen K. Interchangeability of blood gas, electrolyte and metabolite results measured with point-of-care, blood gas and core laboratory analyzers. Clin Chem Lab Med 2011;49:1187-91.  Back to cited text no. 37
    
38.Steinfelder-Visscher J, Teerenstra S, Gunnewiek JM, Weerwind PW. Evaluation of the i-STAT point-of-care analyzer in critically ill adult patients. J Extra Corpor Technol 2008;40:57-60.  Back to cited text no. 38
    
39.Chacko B, Peter JV, Patole S, Fleming JJ, Selvakumar R. Electrolytes assessed by point-of-care testing-Are the values comparable with results obtained from the central laboratory? Indian J Crit Care Med 2011;15:24-9.  Back to cited text no. 39
[PUBMED]  Medknow Journal  
40.Lam HS, Chan MH, Ng PC, Wong W, Cheung RC, So AK, et al. Are your hands clean enough for point-of-care electrolyte analysis? Pathology 2005;37:299-304.  Back to cited text no. 40
    



This article has been cited by
1 Spurious Results in Mineral and Electrolyte Analysis
Elena Gorman
Veterinary Clinics of North America: Small Animal Practice. 2017; 47(2): 263
[Pubmed] | [DOI]
2 Potassium as a potential predictive biomarker of brain hypoxia in avalanche victims: preanalytical recommendations
Denis Monneret
The American Journal of Emergency Medicine. 2016;
[Pubmed] | [DOI]
3 Blood and Plasma Biochemistry Reference Intervals for Wild Juvenile American Alligators (Alligator mississippiensis)
Matthew T. Hamilton,Caitlin A. Kupar,Meghan D. Kelley,John W. Finger,Tracey D. Tuberville
Journal of Wildlife Diseases. 2016;
[Pubmed] | [DOI]
4 Findings of Phlebotomy Practices in Kenya in 2010: Need for Action
Daniel Kimani,Rachel Kamau,Renuka Gadde,Dejana Selenic,Stephen Maina,Lawrence Marum,Gao Hongjiang,Samuel Mwalili,Anthony Marfin,Jane Mwangi
Journal of Infectious Diseases. 2016; 213(suppl 2): S53
[Pubmed] | [DOI]
5 Microfluidic blood plasma separation for medical diagnostics: is it worth it?
W. S. Mielczarek,E. A. Obaje,T. T. Bachmann,M. Kersaudy-Kerhoas
Lab Chip. 2016;
[Pubmed] | [DOI]
6 Potassium measurement in the ED: interpret with caution
Gianfranco Cervellin,Giuseppe Lippi
The American Journal of Emergency Medicine. 2016;
[Pubmed] | [DOI]
7 Kreislaufstillstand in besonderen Situationen
A. Truhlár,C.D. Deakin,J. Soar,G.E.A. Khalifa,A. Alfonzo,J.J.L.M. Bierens,G. Brattebř,H. Brugger,J. Dunning,S. Hunyadi-Anticevic,R.W. Koster,D.J. Lockey,C. Lott,P. Paal,G.D. Perkins,C. Sandroni,K.-C. Thies,D.A. Zideman,J.P. Nolan
Notfall + Rettungsmedizin. 2015; 18(8): 833
[Pubmed] | [DOI]
8 European Resuscitation Council Guidelines for Resuscitation 2015
Anatolij Truhlár,Charles D. Deakin,Jasmeet Soar,Gamal Eldin Abbas Khalifa,Annette Alfonzo,Joost J.L.M. Bierens,Guttorm Brattebř,Hermann Brugger,Joel Dunning,Silvija Hunyadi-Anticevic,Rudolph W. Koster,David J. Lockey,Carsten Lott,Peter Paal,Gavin D. Perkins,Claudio Sandroni,Karl-Christian Thies,David A. Zideman,Jerry P. Nolan
Resuscitation. 2015; 95: 148
[Pubmed] | [DOI]
9 Na+, K+, Cl-, acid–base or H2O homeostasis in children with urinary tract infections: a narrative review
Anna Bertini,Gregorio P. Milani,Giacomo D. Simonetti,Emilio F. Fossali,Pietro B. Faré,Mario G. Bianchetti,Sebastiano A. G. Lava
Pediatric Nephrology. 2015;
[Pubmed] | [DOI]
10 Reactive thrombocytosis and pseudohyperkalemia-entities we come across occasionally
R. Subha,Rachel Cherian Koshy
Egyptian Journal of Anaesthesia. 2015; 31(3): 265
[Pubmed] | [DOI]
11 A multidisciplinary approach to reducing spurious hyperkalemia in hospital outpatient clinics
Tze Ping Loh,Sunil K Sethi
Journal of Clinical Nursing. 2015; 24(19-20): 2900
[Pubmed] | [DOI]
12 Pseudohyperkalemia: A new twist on an old phenomenon
Qing H. Meng,Elizabeth A. Wagar
Critical Reviews in Clinical Laboratory Sciences. 2014; : 1
[Pubmed] | [DOI]
13 Do Hemolyzed Potassium Specimens Need to be Repeated?
Boris Khodorkovsky,Bartholomew Cambria,Martin Lesser,Barry Hahn
The Journal of Emergency Medicine. 2014; 47(3): 313
[Pubmed] | [DOI]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Measurement of P...
Causes of Pseudo...
Reverse Pseudohy...
Masked Hypokalemia
Correction Factors
Whole Blood Testing
Conclusion
References

 Article Access Statistics
    Viewed6270    
    Printed125    
    Emailed6    
    PDF Downloaded1222    
    Comments [Add]    
    Cited by others 13    

Recommend this journal