Document Detail

Correction of factitious hyperkalemia in hemolyzed specimens.
MedLine Citation:
PMID:  16291444     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Hemolysis in pediatric specimens is common due to difficult blood draws and small-bore intravenous catheters. Values of serum K+ become falsely elevated secondary to release of intracellular contents. If a reliable correction factor existed for this factitious elevation, repeat K+ measurements might be avoided. OBJECTIVE: The aim of the study was to establish a correction factor for factitiously elevated K+, using free plasma hemoglobin (p-Hgb) as a measure of in vitro hemolysis. METHODS: Twenty whole-blood specimens drawn from healthy adults via a 23-gauge needle were divided into 4 aliquots: (1) no manipulation, (2) mechanical hemolysis via a 27-gauge needle, (3) addition of potassium acetate (KAc), and (4) addition of KAc and mechanical hemolysis. KAc was added to mimic potentially significant hyperkalemia. All specimens had standard K+ and p-Hgb measurements performed. RESULTS: Nonhemolyzed and hemolyzed K+ ranged from 3.2 to 8.1 mEq/L and 3.5 to 10.0 mEq/L, respectively. A linear relationship existed between the change in K+ and p-Hgb from the nonhemolyzed to hemolyzed specimens. A correction factor for K+ of 0.00319 (95% confidence interval, 0.00290-0.00349) x p-Hgb was obtained. CONCLUSIONS: A reliable correction factor for factitious hyperkalemia in a clinically relevant range exists. By example, using the above correction factor, one can predict that the delta K+ in a specimen with 500 mg/dL of p-Hgb will be 1.6 mEq/L (range, 1.5-1.7). We suggest that when the lower bound of the predicted delta K+ results in a corrected value within the reference range, a second blood draw is unnecessary.
Heather Owens; Georgette Siparsky; Lalit Bajaj; Louis C Hampers
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Publication Detail:
Type:  Controlled Clinical Trial; Journal Article    
Journal Detail:
Title:  The American journal of emergency medicine     Volume:  23     ISSN:  0735-6757     ISO Abbreviation:  Am J Emerg Med     Publication Date:  2005 Nov 
Date Detail:
Created Date:  2005-11-18     Completed Date:  2006-01-19     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8309942     Medline TA:  Am J Emerg Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  872-5     Citation Subset:  IM    
Department of Pediatrics, The Children's Hospital, Denver, CO 80218, USA.
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MeSH Terms
Hemoglobins / metabolism*
Hemolysis / physiology*
Linear Models
Potassium / blood*
Potassium Acetate
Reference Values
Reproducibility of Results
Reg. No./Substance:
0/Hemoglobins; 127-08-2/Potassium Acetate; 7440-09-7/Potassium

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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