Or possibly stabilise at the GP surgery?

 

Yusuf   Yusuf Gray Biomedical Scientist Team Manager – Point of Care Technologies Derbyshire Pathology University Hospitals of Derby and Burton NHS Foundation Trust Royal Derby Hospital   Telephone 01332 788537 Mobile 0737 938 0799 [log in to unmask] www.uhdb.nhs.uk

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We are currently auditing all phoned out K results > 6.5 mmol/l. There are 6-7 every day phoned to primary care and over the last 6 weeks of the audit all were pseudohyperkalaemias – the majority of  patients were sent urgently to A&E.

 

One has to really wonder about the value of K as part of the GP electrolyte profile – it is certainly causing a lot of harm. Other ways to resolve – better, more regular transport, GP centrifuges, phlebotomy hubs. We remove potassium results from all samples > 24 hours old, and put a warning/disclaimer on all those between 6-24 hours. Perhaps we need to remove all > 6 hours or lower?

 

 

 

Such a difficult issue

 

A more controversial solution is to de-couple electrolytes from a GP-requested renal function altogether.

Is NA+ and K+ as part of routine renal function in a GP setting adding much value or causing more harm?

 

In my experience the vast majority of spurious cases occur in people having routine bloods ..…but of course if there was a legitimate reason to request electrolytes then it could be included as a separate request

 

Shivani

 

Shivani Misra MRCP, FRCPath, PhD

Consultant in Metabolic Medicine & Diabetes

Imperial College Healthcare NHS Trust

 

This was becoming a major issue for us too. We were finding that many cases of spurious hyperkalaemia (primarily due to delay between bleed and spin) were not being picked up. We’ve had to have a complete re-think on sample reception logistics and we now stipulate that all primary care ‘critical’ hyperkalaemias have to be reviewed by the on call consultant biochemist before being phoned to out. These can be very difficult decisions to make!

 

Stuart

 

From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of Mike Addison
Sent: 01 March 2019 12:38
To: [log in to unmask]
Subject: Pseudohyperkalaemia

 

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