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Hyperkalemia in a Hemolyzed Sample in Pediatric Patients: Repeat or Do Not Repeat?
Rahul Kaila1, Marissa Hendrickson1, Pablo Avendano1
1From the University of Minnesota Masonic Children's Hospital.
Insights
Repeat potassium testing may be unnecessary for healthy children with hemolyzed samples in the pediatric emergency department. Most cases of apparent hyperkalemia due to hemolysis are not true hyperkalemia, avoiding unnecessary repeat blood draws.
Area of Science:
- Pediatric Emergency Medicine
- Clinical Pathology
- Laboratory Medicine
Background:
- Hemolysis is a common issue in pediatric blood samples.
- Hemolysis can falsely elevate potassium levels, mimicking hyperkalemia.
- Distinguishing true hyperkalemia from pseudohyperkalemia is crucial for appropriate patient management.
Purpose of the Study:
- To evaluate the necessity of repeat potassium testing in children presenting to the emergency department with hyperkalemia on a hemolyzed sample.
- To determine the incidence of true hyperkalemia in pediatric patients with hemolyzed specimens and elevated potassium levels.
Main Methods:
- Retrospective analysis of 5 years of pediatric emergency department patient data.
- Inclusion criteria: patients aged 0-17 years with elevated potassium on a hemolyzed serum sample.
- Analysis of repeat potassium levels and associated clinical factors.
Main Results:
- 187 pediatric patients with hemolysis and hyperkalemia were analyzed.
- Of 145 children with repeat sampling, 97.9% had normal potassium levels.
- Only 2.1% (3 children) had true hyperkalemia, all with underlying conditions suggesting hyperkalemia.
Conclusions:
- Repeat potassium testing may not be necessary for hemolyzed samples in healthy children if blood urea nitrogen and creatinine are normal.
- This finding can help streamline emergency department workflows and reduce unnecessary laboratory tests.
- Further investigation into specific clinical indicators alongside lab results is warranted.
Objective:
The aim of the study is to analyze whether repeat testing is necessary in healthy children presenting to a pediatric emergency department (ED) who are found to have hyperkalemia on a hemolyzed specimen.
Methods:
A 5-year retrospective analysis of pediatric ED patients found to have elevated potassium values on laboratory testing of a sample reported to be hemolyzed. All patients aged 0 to 17 years who had an elevated potassium level after an intravenous draw resulted from a serum sample that was reported as hemolyzed during an ED visit were included in the study.
Results:
One hundred eighty-seven patients with some degree of both hemolysis and hyperkalemia were included in the final analysis. The median age was 1.9 years of age. The most common race among all patients was White, followed by African American, and Asian. One hundred forty-five children had repeat sampling for hemolyzed hyperkalemia, 142 children, 97.9% (95% confidence interval, 95.6%-100%) had a normal potassium on repeat and 3 children, 2.1% (95% confidence interval, 0.0%-4.4%) had true hyperkalemia. The frequency of true hyperkalemia in our study population was 2% (3/145). All 3 of these patients had underlying conditions that would appropriately have raised clinician suspicion for hyperkalemia.
Conclusions:
It may be unnecessary to obtain repeat samples to confirm normal potassium in a hemolyzed sample with normal blood urea nitrogen and creatinine.
