scott@vtx-cpd.com
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Replying to Kathryn B. 23/10/2022 - 20:13
My exact reaction!
My first thought was indeed, is this compatible with life!!!! I discussed the following wit the clinet first:
Pseudohyperkalaemia – translocation of potassium from cells post-collection
Asian dog breeds (Akita, Shiba Inu, Jindo, Chow Chow, Shar pei)
Haemolysis
Delayed serum separation
Markedly increased platelets or white blood cell countArtifact:
Collection from IV line where potassium was administered
EDTA contaminationThe sample was run again on the same machine with the same result. The sample was then run at another practice and at the reference lab and was indeed real!
The DDX for high potassium are as follows:
Decreased potassium excretion
Hypoadrenocorticism (Addison’s disease)
Acute anuric or oliguric kidney failure
Urinary obstruction or ruptured bladder
Hypoaldosteronism
Drugs (e.g. ACE inhibitors, trimethoprim, spironolactone)
Selected gastrointestinal diseases (e.g. whipworms, salmonellosis, perforated duodenal ulcer)
Potassium translocation from intracellular fluid to extracellular fluid
Metabolic acidosis due to increased organic acids (e.g. ketones, lactate)
Diabetes mellitus with hyperosmolar syndrome
Tissue necrosis, severe
Acute tumour lysis syndrome
Reperfusion syndrome
Aortic thromboembolism
Rhabdomyolysis/muscle necrosis (e.g. post-seizure, strenuous exercise)
Hyperkalaemic periodic paralysis
Post-exercise in hypothyroid dogs (mild increase)
Increased intake
Administration of potassium rich fluids
Dietary excess
Pleural effusion and ascitesAs you mentioned, many of these DDX are ruled out from examination etc. My other big concern was the low sodium. I thought an ACTH would be sensible!
Will update soon!
Scott 🙂