Quantum Medical Update is a CME initiative produced by the in-house clinical team of Quantum Diagnostics. This monthly newsletter is in-line with our commitment to better service our doctors.

1. Dear Colleague,
In line with our core principles of transparency and building trust with healthcare professionals we report all blood results
that we analyze with integrity. We believe it is our duty to our customers to provide them with accurate clinical information
and we do this in accordance to the standards required of us by our MS ISO 15189 accreditation. We also want to empower
doctors with the knowledge to make better decisions for their patients.
QuantumA Matter of Life
HYPERKALEMIA
PATHOGENESIS
Excessive Intake
K+ supplements
High K+ diet
Impaired Elimination
Renal insufficiency
Obstructive uropathy
Hypoaldosteronism
Renal tubular disease
Congestive heart failure
Constipation
Medication:
1) ACEI/ARBs
2) K+ Sparing Diuretics
3) NSAIDs
4) Trimethoprim
5) Cyclosporin
Intracellular Shift
Acidosis
Diabetes Mellitus
Acute cell-tissue breakdown
Periodic paralysis
Medication:
1) Digoxin
2) Beta Blockers
Relevant P MHx/ Identifiable acute cause
from clinical context
K+>5.5 mmol/L
YES - Treat
underlying
cause
NO - Further
investigations
required
Blood Glucose Level - Diabetes Mellitus
Urinalysis - Renal insufficiency
Arterial/Venous Blood Gas - Acidosis
Serum CPK - Rhabdomyolysis
Serum Cortisol and Aldosterone - Adrenal insufficiency
Serum Uric Acid and Phosphorus - Tumour lysis syndrome
Consider spurious result if patient asymptomic and above causes
unlikely. Refer to spurious results checklist.
Hyperkalemia is a potentially life-threatening medical emergency. If clinically
suspected, patient should be urgently treated before further investigations are
performed to identify the cause.
L3-5, 3rd Floor Wisma Kemajuan,
No.2, Jalan 19/1B, 46300 Petaling Jaya, Selangor.
T. 1300-13-3522
(Co no. 941541-V)
Quantum Diagnostics Sdn Bhd
QUANTUM MEDICAL UPDATE
Issue 1 www.quantumdxs.comBringing Science to LIFE
Produced by Dr. Tan Shih Yang, Medical Affairs
sytan@quantumdxs.com
MS ISO 15189

2. Spurious Hyperkalemia/Pseudohyperkalemia
Spurious (false/factitious) hyperkalemia (AKA pseudohyperkalemia) is a common and widely acknowledged problem in
the laboratory medicine industry. This is especially so in community-based laboratories working with specimens outside
of the hospital environment due to the magnification of the pre-analytical issues highlighted below. Even with our
stringent QC processes, a percentage of our samples tested record a potassium reading of >5.5. This finding is consistent
across our regional sister labs in Singapore and the Philippines. This document seeks to identify the common causes of
spurious hyperkalemia and provide specific measures clinicians can take to help reduce its occurrence.
Potassium is an analyte that is very sensitive to pre-analytical conditions. 98% of the body’s potassium is in intracellular
stores. This allows the remaining extracellular 2% to be tightly regulated. As a result of this, even a small release of
intracellular potassium results in a potentially significant rise in measured potassium values, resulting in a spurious result.
For completeness, we have included both the pre-analytical and analytical causes of spurious results. The sections on
patient factors and blood collection and storage are the areas that clinicians should pay particular attention to in order to
reduce the incidence of spurious hyperkalemia.
Patient Factors
Ensure that the patient is calm and not distressed - Hyperventilation associated with fear and crying has been
known to produce a transient hyperkalemic response
Blood Collection and Storage
Ensure that best practice venepuncture technique is used - please refer to our supplement on venepuncture best
practice for this
Ensure that the sample is stored correctly after collection – store sample at 15-25°C (specifically, do not store in
fridge)
Alternatively, refer the patient to one of Quantum Diagnostics’ collection centres for venepuncture
Logistics
Ensure that the sample is processed within 4 hours of collection - our couriers strive to ensure all our samples
reach our lab in the required time window. To enable this, please inform our customer service desk once urgent
specimens are ready for collection.
Ensure that the sample is delivered appropriately - our couriers are appropriately trained and provided with the
equipment required for transporting samples
Processing and Analysis
Ensure that samples are processed appropriately (ie handling, storage and centrifuging) – all of our lab
technicians are trained and abide by our strict standard operating procedures
Ensure that samples are analysed appropriately - our lab operates and abides by strict standard operating
procedures and we run the appropriate calibrations and QCs in line with our MS ISO 15189 accreditation
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References:
1. Errors in potassium measurement: a laboratory perspective for the clinician. Asirvatham et al. N Am J Med Sci. 2013 Apr;5(4):255-9.
2. Spurious electrolyte disorders: a diagnostic challenge for clinicians. Liamis et al. Am J Nephrol. 2013;38(1):50-7.
3. Elevated serum potassium levels: the role of preanalytic variables. Stankovic et al. Am J Clin Pathol. 2004 Jun;121 Suppl:S105-12.
Disclaimer of Medical Liability
Quantum Diagnostics Sdn Bhd and the author are not responsible or liable for any advice, course of treatment, diagnosis or any other information, services or
products that an individual obtains through this document. This document is not for use in medical emergencies and users should exercise their own clinical
judgment in their practice.