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Factitious hyperkalemia.

M R Wiederkehr1, O W Moe

  • 1Division of Nephrology and Hypertension, University of Bern, Switzerland. michaelwiederkehr@hotmail.com

American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation
|October 31, 2000
PubMed
Summary

Tourniquet use during blood draws can cause pseudohyperkalemia, an artificially high potassium level. This study found significant variability in potassium increases, highlighting the importance of recognizing factitious hyperkalemia.

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Area of Science:

  • Clinical Chemistry
  • Laboratory Medicine
  • Phlebotomy Techniques

Background:

  • Pseudohyperkalemia, or factitious hyperkalemia, is an artificially elevated plasma potassium level (P(K)) with various potential causes.
  • Occasionally, the source of pseudohyperkalemia remains unidentified, necessitating further investigation into common phlebotomy practices.

Observation:

  • Investigated the impact of tourniquet application during routine phlebotomy on plasma potassium levels.
  • Observed three patients with significant differences between free-flowing and tourniquet-induced (stasis) potassium measurements.
  • Evaluated eight healthy volunteers to quantify the effect of tourniquets on P(K).

Findings:

  • Tourniquet use resulted in a consistent, albeit small, average increase in P(K) of 0.2 mEq/L (P < 0.001).
  • A wide range of P(K) increase (0.05 to 0.5 mEq/L) was observed among subjects, indicating substantial individual variability.
  • Patients presented with markedly excessive P(K) increases averaging 1.6, 1.3, and 1.7 mEq/L.

Implications:

  • Recognizing factitious hyperkalemia due to tourniquet use is crucial to avoid unnecessary diagnostic workups.
  • Preventing excessive tourniquet time can mitigate potentially hazardous interventions associated with misdiagnosed hyperkalemia.
  • Understanding phlebotomy-induced P(K) variations aids in accurate patient assessment and management.

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