Pseudohypercalemia in clinical practice. A review

A nephrologist diagnoses various clinical and laboratory syndromes and their combinations in practice: dyselectrolytemia; nephritic syndrome, nephrotic syndrome, urinary syndrome, anemia, thrombocytosis, leukocytosis, thrombophilia, paraproteinemia, and others. Persistent and severe hyperkalemia can cause the development of ventricular rhythm disturbances, paresis, paralysis, and death, and for these reasons requires treatment. Pseudohyperkalemia does not require treatment and, therefore, it is necessary to differentiate these two conditions promptly to choose the optimal treatment and avoid non-indicated interventions. A search was carried out in the MEDLINE / PubMed, EMBASE, and Web of Science databases using the keywords: pseudohyperkalemia, and kidney disease to study the causes of pseudohyperkalemia, patient management tactics. Violations in the collection, transportation, storage of blood, preparation for analysis, and hemolysis can be the causes of pseudohyperkalemia. Currently, there are two main methods for assessing hemolysis: visual and instrumental. The visual method for assessing hemolysis is poorly consistent with the actual content of free hemoglobin in serum/plasma. An instrumental method based on a photometric method for measuring the content of free hemoglobin (hemolysis index) in the patient's serum/plasma is more accurate. Thrombocytosis, erythrocytosis, and leukocytosis are the causes of pseudohyperkalemia. With thrombocytosis, more than 500 × 109/l and/or erythrocytosis, pseudohyperkalemia in the blood serum is diagnosed. With leukocytosis more than 15-50 × 109/l, reverse pseudohyperkalemia with an increase in the level of potassium in the plasma is verified. The literature presents clinical cases with alternating true hyperkalemia and pseudohyperkalemia in the same patient. Familial pseudohyperkalemia has been also described. The diagnostic criteria for pseudohyperkalemia were determined. Pseudohyperkalemia is verified with an increase in serum potassium levels with normal plasma potassium levels, with a difference between serum and plasma potassium levels of more than 0.4 mmol/l, in the absence of clinical symptoms (weakness, paresthesia, convulsions, paralysis) and changes in the electrocardiogram ("pointed" T waves, lengthening of the PR interval, decrease in amplitude and expansion of the P wave, expansion of the QRS complex, slowing of atrioventricular conduction, and others).

псевдогиперкалиемия, гемолиз, цитоз, заболевания почек, pseudohyperkalemia, hemolysis, cytosis, kidney disease

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