Hyperkalemia in a Hemolyzed Sample in Pediatric Patients: Repeat or Do Not Repeat?

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.