Do hemolyzed potassium specimens need to be repeated?

Background: In the emergency department (ED), hyperkalemia in the presence of hemolysis is common. Elevated hemolyzed potassium levels are often repeated by emergency physicians to confirm pseudohyperkalemia and to exclude a life-threatening true hyperkalemia. Objectives: We hypothesize that in patients with a normal renal function, elevated hemolyzed potassium, and normal electrocardiogram (ECG), there may not be a need for further treatment or repeat testing and increased length of stay. Methods: Data were prospectively enrolled patients presenting to the ED from July 2011 to February 2012. All adult subjects who had a hemolyzed potassium level \u3e= 5.5 mEq/dL underwent a repeat potassium level and ECG. The incidence of true hyperkalemia in this population was measured. Results: A total of 45 patients were enrolled. The overall median age was 52 years (range 25-83 years); 22 were female (49%). In patients with hyperkalemia on initial blood draw and glomerular filtration rate (GFR) \u3e= 60 (n = 45), the negative predictive value was 97.8% (95% confidence interval [CI] 88.2-99.9%). When patients had hyperkalemia on initial blood draw, GFR \u3e= 60, and a normal ECG (n = 42), the negative predictive value was 100% (95% CI 93.1-100%). Conclusions: In the setting of hemolysis, GFR \u3e= 60 mL/min in conjunction with a normal ECG is a reliable predictor of pseudohyperkalemia and may eliminate the need for repeat testing. In patients with a normal GFR who are otherwise deemed safe for discharge, our results indicate there is no need for repeat testing. (C) 2014 Elsevier Inc