A case of hyperkalaemia associated with hypocalcaemia

Stevens, Roger; Laina, V; Wong, Chris; Coulson, C E

doi:10.1136/emj.2007.056903

Cited by 7 publications

(10 citation statements)

References 9 publications

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“…Factitious hyperkalaemia (2), hypocalcaemia and hypomagnesaemia caused by potassium EDTA contamination in our studies are relatively common, and if unrecognised, it may adversely affect patient care and waste scarce healthcare resources (4,5). Gross potassium EDTA contamination is easy to detect as it causes unexpected and marked hyperkalaemia and hypocalcaemia with, if measured, hypomagnesaemia and hypozincaemia (Table 1).…”

Section: Discussionmentioning

confidence: 71%

EDTA sample contamination is common and often undetected, putting patients at unnecessary risk of harm

Sharratt

Gilbert

Cornes

et al. 2009

International Journal of Clinical Practice

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BackgroundPotassium ethylenediaminetetraacetic acid (EDTA) is a sample tube anticoagulant used for many laboratory analyses. Gross potassium EDTA contamination of blood samples is easily recognised by marked hyperkalaemia and hypocalcaemia (1-3). Subtle potassium EDTA contamination, however, is a relatively common often unrecognised erroneous cause of spurious hyperkalaemia (2). This has the potential to adversely affect patient care and waste healthcare resources (4,5).In addition to hyperkalaemia and hypocalcaemia, potassium EDTA contamination may also cause hypomagnesaemia (1,2) and hypozincaemia (2). There are, however, no data on the prevalence of EDTA contamination as a cause of hypocalcaemia, hypomagnesaemia and hypozincaemia. We therefore audited the prevalence of EDTA contamination as a cause of hypocalcaemia, hypomagnesaemia and hypozincaemia over a 1-month period. MethodsFollowing a recent service evaluation (2), we routinely measure EDTA in serum samples from patients with unexplained hyperkalaemia (serum potassium > 6.0 mmol ⁄ l).In addition, over a 1-month period EDTA concentrations were measured in hypocalcaemic (serum adjusted calcium < 2.0 mmol ⁄ l), hypomagnesaemic (serum magnesium < 0.7 mmol ⁄ l) and hypozincaemic (serum zinc < 11 lmol ⁄ l) serum samples.Blood samples for routine serum biochemistry, plasma glucose and routine haematology are respectively collected into Sarstedt serum ⁄ z4 gel tubes, S U M M A R YBackground: Potassium ethylenediaminetetraacetic acid (EDTA) is a sample tube anticoagulant used for many laboratory analyses. Gross potassium EDTA contamination of blood samples is easily recognised by marked hyperkalaemia and hypocalcaemia. However, subtle contamination is a relatively common, often unrecognised erroneous cause of spurious hyperkalaemia. Potassium EDTA contamination may also cause hypomagnesaemia and hypozincaemia. There are, however, no data on the prevalence of EDTA contamination as a cause of hypocalcaemia, hypomagnesaemia and hypozincaemia. Methods: Following a recent service evaluation, we measure EDTA in serum samples from patients with unexplained hyperkalaemia (serum potassium > 6.0 mmol ⁄ l). In addition, over a 1-month period EDTA concentrations were measured in hypocalcaemic (serum adjusted calcium < 2.0 mmol ⁄ l), hypomagnesaemic (serum magnesium < 0.7 mmol ⁄ l) and hypozincaemic (serum zinc < 11 lmol ⁄ l) serum samples. Results: Ethylenediaminetetraacetic acid contamination was detected in 31 samples, nine of which were detected by our routine screening programme. The remaining 22 samples represented 14.3% (19 ⁄ 133) of hypocalcaemic samples, 4.8% (5 ⁄ 104) of hypomagnesaemic samples and 1.4% (2 ⁄ 139) of hypozincaemic samples. A total of 25 ⁄ 31 (80.6%) of patients were re-bled, of which 23 ⁄ 25 (92%) results normalised. Conclusions: Factitious hyperkalaemia, hypocalcaemia and hypomagnesaemia caused by potassium EDTA contamination in our studies are relatively common, and if unrecognised may adversely affect patient care and waste scarce healthcare reso...

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Section: Discussionmentioning

confidence: 71%

EDTA sample contamination is common and often undetected, putting patients at unnecessary risk of harm

Sharratt

Gilbert

Cornes

et al. 2009

International Journal of Clinical Practice

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“…local tissue damage, experience of the phlebotomist) rather than the order of draw. However, the discussion is still ongoing (Stevens et al, 2008;Sharratt et al, 2009;Cornes et al, 2010;Ijaz et al, 2010).…”

Section: Effects Of Anticoagulants and Gel Separatorsmentioning

confidence: 99%

Pre-analytical factors affecting the results of laboratory blood analyses in farm animal veterinary diagnostics

Humann-Ziehank

Ganter

2012

Animal

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The quality of the laboratory diagnostic approach in farm animals can be severely affected by pre-analytical factors of variation. They induce increase/decrease of biochemical and hematological analyte concentrations and, as a consequence, they may cause unsuitable conclusions and decisions for animal health management and research projects. The pre-analytical period covers the preparation of sampling, the sampling procedure itself, as well as all specimen handling until the beginning of the specific laboratory analysis. Pre-analytical factors may have either an animal-related or a technique-related background. Animal-related factors cover daytime/season, meals/fasting, age, gender, altitude, drugs/anesthesia, physical exercise/stress or coinfection. Technique-related factors are the choice of the tube including serum v. plasma, effects of anticoagulants/gel separators, the anticoagulant/blood ratio, the blood collection procedure itself, specimen handling, contamination, labeling, storage and serum/plasma separation, transportation of the specimen, as well as sample preparation before analysis in the laboratory. It is essential to have proper knowledge about the importance and source of pre-analytical factors to alter the entire diagnostic process. Utmost efforts should be made to minimize controllable factors. Analytical results have to be evaluated with care considering that pre-analytical factors of variation are possible causes of misinterpretation.

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“…Moreover, Hypomagnesemia can also be caused by Potassium EDTA contamination which may lead to false result and adversely affect patient care and cost for testing. 4,5 The team in the lab had not been involved in measuring serum magnesium levels, however all contaminated (65) samples analysed for absurd and high potassium, calcium results were taken in account and an average was concluded to be as K-29 mmol/L and calcium as 0.99 mg/dl which (Table 2) seemed to support the hypothetical suspicion.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, Hypomagnesemia can also be caused by Potassium EDTA contamination which may leads to false result and adversely affect patient care and cost for testing. 4,5 Absurd Value are not feasible in living person. Hypocalcemia, hypomagnesemia and hyperkalemia with absurd values caused by potassium EDTA contamination is very common.…”

Section: Introductionmentioning

confidence: 99%

“…It may adversely cost patient's health and waste medical resources. 5,6 Potassium EDTA easily gets detected by hyperkalemia and hypocalcemia if measured, with hypomagnesemia and hypozincemia. 7 UIBC measurements in conjunction with serum iron measurements are used in the diagnosis and treatment of hereditary hemochromatosis and other iron disorders.…”

Section: Introductionmentioning

confidence: 99%

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EDTA contamination: a preanalytical cause for interference in iron and unsaturated iron binding capacity assay

et al. 2020

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Background: The aim of the study is focussed very keenly at performing RCA (root cause analysis) of those particular sample containing the absurd results of the Serum UIBC (Unsaturated Iron Binding Capacity), which was also tallied vigilantly side by side with Serum Iron observed at Clinical Biochemistry laboratory of The New Civil Hospital Surat, Gujarat.Methods: The Absurd value from the samples requested for Serum Iiron and Serum Serum UIBC (Unsaturated Iron Binding Capacity) from month of August 2018 till the month of August 2019 were taken in to account for analysis. RCA (root cause analysis) of absurd value for Serum Iron and Serum UIBC (Unsaturated Iron Binding Capacity) which were prepared was mainly focused on tallying with Serum Calcium and Serum Potassium result.Results: With the continious and strenous monitoring from the side of the researchers, the researchers had throughly analysed and found that in almost all of those analysed test containing absurd results of Serum Iron and Serum UIBC(Unsaturated Iron Binding Capacity) which were some way or the other, associated with absurd results of Serum Calcium along with absurd result of Serum Potassium too from the same samples.Conclusions: The Absurd results of Serum Calcium and Serum Potassium are caused mainly due to pre-analytical errors more likely due to the sample contamination with EDTA (ethylene diamine tetra acetic acid). The contaminated EDTA (ethylene diamine tetra acetic acid) sample cause interference in Serum Iron measurement by producing turbidity in sample and in Serum UIBC (Unsaturated Iron Binding Capacity) by chelating Iron.

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A case of hyperkalaemia associated with hypocalcaemia

Cited by 7 publications

References 9 publications

EDTA sample contamination is common and often undetected, putting patients at unnecessary risk of harm

EDTA sample contamination is common and often undetected, putting patients at unnecessary risk of harm

Pre-analytical factors affecting the results of laboratory blood analyses in farm animal veterinary diagnostics

EDTA contamination: a preanalytical cause for interference in iron and unsaturated iron binding capacity assay

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