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Making, Testing, and Using Potassium Ion Selective Microelectrodes in Tissue Slices of Adult Brain
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Potassium Reference Intervals: A Need for Separate Reference Intervals for Serum and Plasma.

Glen L Hortin1,2, Joseph Leonard3, Claude Bassil4

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Laboratory reference intervals for potassium vary significantly, impacting patient care. Using separate reference intervals for serum and plasma potassium improves accuracy and clinical assessment.

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Area of Science:

  • Clinical Chemistry
  • Laboratory Medicine
  • Medical Diagnostics

Background:

  • Accurate potassium measurement is critical for preventing life-threatening arrhythmias and managing dyskalemia.
  • Preanalytical factors and specimen types (serum, plasma, whole blood) complicate potassium measurement and interpretation.
  • Mild dyskalemia is linked to adverse clinical outcomes, highlighting the need for precise diagnostics.

Purpose of the Study:

  • To evaluate the variability of potassium reference intervals (RIs) across laboratories.
  • To assess the impact of using common serum RIs for plasma potassium measurements.
  • To determine the necessity of distinct RIs for serum and plasma potassium.

Main Methods:

  • Acquired adult potassium RIs from 60 laboratory directories.
  • Analyzed plasma potassium distributions at a cancer center.
  • Evaluated the effects of applying different RIs to patient plasma potassium values.

Main Results:

  • Laboratories utilize 14 distinct RIs for serum potassium, with most applying the same RI for both serum and plasma.
  • Only 4 laboratories reported different RIs for serum and plasma.
  • Applying serum RIs to plasma measurements significantly altered the proportion of patient results falling outside the established RI.

Conclusions:

  • Significant variation exists in laboratory potassium RIs, despite standardization efforts.
  • Using identical RIs for serum and plasma is suboptimal, as measurements typically differ by 0.2-0.4 mmol/L.
  • Separate RIs for serum and plasma potassium are recommended for improved patient assessment, especially in acute care settings where plasma testing is prevalent.