| Autor: |
Li TC; Division of Nephrology, Department of Pediatrics, Taichung Veterans General Hospital, Taichung, Taiwan., Chan WC; Division of Occupational Medicine, Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung, Taiwan., Tsai MC; Division of Nephrology, Department of Pediatrics, Taichung Veterans General Hospital, Taichung, Taiwan., Tsai SF; Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.; Department of Life Science, Tunghai University, Taichung, Taiwan.; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan., Jan SL; Division of Cardiology, Department of Pediatrics, Taichung Veterans General Hospital, Taichung, Taiwan.; School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan., Fu LS; Division of Nephrology, Department of Pediatrics, Taichung Veterans General Hospital, Taichung, Taiwan.; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.; College of Medicine, National Chung Hsing University, Taichung, Taiwan., Huang FL; Division of Hematology and Oncology, Department of Pediatrics, Taichung Veterans General Hospital, Taichung, Taiwan.; Hung Kuang University, Taichung, Taiwan.; Institute of Biomedical Sciences, MacKay Medical College, New Taipei City, Taiwan., Huang YC; Division of Nephrology, Department of Pediatrics, Taichung Veterans General Hospital, Taichung, Taiwan.; College of Medicine, National Chung Hsing University, Taichung, Taiwan.; Doctoral Program in Translational Medicine, National Chung Hsing University, Taichung, Taiwan. |
| Abstrakt: |
Patients with newly diagnosed hematological malignancies often present with a considerable cellular burden, leading to complications including hyperkalemia. However, pseudohyperkalemia, arising from in vitro cell lysis, can pose challenges in clinical practice. Although pseudohyperkalemia is frequently reported in adult hematological malignancies, its occurrence in pediatric patients is underreported, and its incidence in this demographic remains unclear. We retrospectively reviewed the medical records of pediatric patients who received a new diagnosis of hematological malignancies from 2011 to 2022 at Taichung Veterans General Hospital. Hyperkalemia was defined by a serum or plasma potassium level exceeding 5.5 mEq/L. Pseudohyperkalemia was defined by 1) a potassium decrease of over 1 mEq/L in within 4 h without intervention or 2) the absence of electrocardiography changes indicative of hyperkalemia. Cases with apparent red blood cell hemolysis were excluded. A total of 157 pediatric patients with a new diagnosis of hematological malignancies were included, 14 of whom exhibited hyperkalemia. Among these 14 cases, 7 cases (4.5%) were of pseudohyperkalemia. This rate increased to 21.2% in patients with initial hyperleukocytosis. Pseudohyperkalemia was associated with a higher initial white blood cell count and lower serum sodium level. All episodes of pseudohyperkalemia occurred in the pediatric emergency department, where samples were obtained as plasma, whereas all true hyperkalemia cases were observed in the ordinary ward or intensive care unit, where samples were obtained as serum. Timely recognition of pseudohyperkalemia is crucial to avoiding unnecessary potassium-lowering interventions in pediatric patients with newly diagnosed hematological malignancies. |
