Reducing the Incidence of Pseudohyperkalemia by Avoiding Making a Fist During Phlebotomy: A Quality Improvement Report

A multidisciplinary approach to reducing spurious hyperkalemia in hospital outpatient clinics

“…The WHO recommendation should probably be revised in view of the recent evidence against such practice (Seimiya et al . ).…”

“…A detailed literature review was undertaken to identify potential causes of spurious hyperkalemia (Stankovic & Smith , Seimiya et al . , World Health Organization , Asirvatham et al . , Lippi et al .…”

“…Fist clenching/pumping can transiently increase the serum potassium by up to 26%, and may lead to spurious hyperkalemia of more than 6·5 mmol/l (Seimiya et al . ). This is mediated by the release of potassium from the skeletal muscle that is actively contracting.…”

“…It is suspected when the serum potassium result is significantly elevated in an apparently well patient, particularly in the absence of stage 5 chronic kidney disease (Hawkins 2009). There are multiple causes of spurious hyperkalemia such as prolonged application of tourniquet, overly rigorous blood tube inversion and leaving the blood tube at room temperature for a prolonged period of time (Seimiya et al 2010). Fist clenching/pumping can transiently increase the serum potassium by up to 26%, and may lead to spurious hyperkalemia of more than 6Á5 mmol/l (Seimiya et al 2010).…”

“…There are multiple causes of spurious hyperkalemia such as prolonged application of tourniquet, overly rigorous blood tube inversion and leaving the blood tube at room temperature for a prolonged period of time (Seimiya et al 2010). Fist clenching/pumping can transiently increase the serum potassium by up to 26%, and may lead to spurious hyperkalemia of more than 6Á5 mmol/l (Seimiya et al 2010). This is mediated by the release of potassium from the skeletal muscle that is actively contracting.…”