This is Steve Carroll, and you're listening to the Am Basic podcast. Today, we're going to talk about

how to manage patients with a high potassium level, also known as hyperculemia. After hyponetremia,

this is the second most common cause of serious electrolyte abnormalities that we see in the emergency

department. So we need to have a methodical approach to this problem, so let's get started.

As always, this podcast doesn't represent the fused of opinions of the Department of Defense, U.S. Army, or the Fort Hood post-command.

Let's start this podcast off with a patient with hyperculemia.

So you have a patient with a potassium of 8.

So let's call nephrology and start dialysis, right? Not so fast.

The very first thing that we have to address is whether or not the potassium measurement is for real.

This is because the number one cause of hyperclineia is pseudohyperchlemia. We often call this lab error,

although this is usually our fault when we draw the blood.

What happens is that when the blood is drawn, if it is drawn out too quickly, then the blood

can hemalyze.

This is when the blood cells hit the wall of the tube and lights open, and they spill their

potassium.

When this happens, it falsely elevates the measured potassium level.

Whenever you get a patient with a high potassium, check for the level of homilysis.

There is no standard way of reporting homolysis that I have seen.

I have seen measurements of either 1 to 4 plus or small, medium, large, and gross homolysis.

There is no good rule of thumb to say how much homilocyst is acceptable for a particular

level of potassium. So you have to make a judgment call. If you have a patient with a slightly

high potassium of 5.2, but 2 plus homolysis, then I wouldn't be that worried. However, if you have a patient

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