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A case of 'reverse' pseudohyperkalemia

P J Singh¹, E T Zawada, R N Santella

¹Department of Internal Medicine, University of South Dakota School of Medicine, Sioux Falls 57105-1570, USA.

Mineral and Electrolyte Metabolism

|January 1, 1997

Summary

Pseudohyperkalemia, a condition where serum potassium exceeds plasma potassium, was observed in reverse. This unusual case involved higher plasma than serum potassium, potentially due to heparin sensitivity in hematological malignancy.

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Area of Science:

Clinical Chemistry
Hematology
Pathophysiology

Background:

Pseudohyperkalemia is typically caused by potassium release during clotting from high blood cell counts.
It is defined as a serum potassium level exceeding the plasma potassium level by 0.4 mmol/l.

Observation:

An unusual case presented with higher plasma potassium concentrations than serum potassium.
Heparin anticoagulant was used in the plasma collection tubes.

Findings:

The reversed potassium gradient (plasma > serum) is contrary to typical pseudohyperkalemia.
Heparin's known cell-lysing properties are implicated in this specific observation.

Implications:

This case suggests a potential mechanism for reversed pseudohyperkalemia.
Heightened sensitivity to heparin-induced membrane damage, possibly linked to hematological malignancy, is proposed.
Highlights the importance of considering anticoagulant type and patient's hematological status in interpreting potassium levels.

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