Not all unexplained hyperkalaemia is pseudohyperkalaemia.

Area of Science:

• Clinical Medicine
• Pathology
• Medical Diagnostics

Background:

• Hyperkalaemia is a critical condition requiring accurate diagnosis.
• Pseudohyperkalaemia can arise from sample handling issues, complicating true hyperkalaemia diagnosis.
• Localized rhabdomyolysis is a potential cause of significant potassium elevation.

Observation:

• A patient presented with hyperkalaemia, initially suspected as pseudohyperkalaemia due to a normal potassium level in a sample from the contralateral arm.
• Elevated creatine kinase and lactate dehydrogenase levels in a subsequent sample prompted further investigation.
• Clinical reassessment confirmed localized rhabdomyolysis secondary to upper limb arterial occlusion.

Findings:

• The patient's hyperkalaemia was definitively linked to localized rhabdomyolysis caused by upper limb ischemia.
• Systematic scrutiny of pathology results by laboratory staff was crucial in identifying the discrepancy.
• Prompt diagnosis and treatment of arterial occlusion led to successful patient recovery.

Implications:

• This case underscores the importance of meticulous review of all pathology results, especially when clinical presentation is atypical.
• It highlights the essential role of laboratory diagnostics in identifying subtle but critical conditions.
• Effective interdisciplinary communication between laboratory and clinical teams is vital for optimal patient care.