Hyperkalemia diagnostic study of choice: Difference between revisions

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Revision as of 23:54, 5 July 2018

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Overview

Diagnostic Study of Choice

Study of choice

[Serum potassium] is the gold standard test for the diagnosis of [hyperkalemia].

There are two methods to determine serum potassium :

Flame emission spectrophotometry

Ion-specific electrode (ISE) potentiometry

ISE potentiometry has two different subtypes: Direct (undiluted) and indirect (diluted).

Direct ISE measures plasma potassium directly from a whole-blood sample and it's not associated with either pseudohyperkalemia.

FES or indirect ISE requires sample dilution before assay and both are associated with pseudohyperkalemia.

Pseudohyperkalemia

Pseudohyperkalemia is defined when serum potassium concentration exceeds that of plasma without any symptoms of hyperkalemia.It usually occurs when potassium moves out of cells during blood specimen collection or during centrifugation of the sample.Other causes are thrombocytosis,leukocytosis and erythrocytosis.To rule out pseudohyperkalemia we need to do the following

*Repeat the blood sample

*Complete blood count to rule out thrombocytosis,erythrocytosis and leukocytosis

*Measurement of plasma potassium and whole blood potassium

Diagnostic results

The finding on performing the diagnostic test that confirms hyperkalemia

*Serum Potassium level more than 5.1 meq/L.

Sequence of Diagnostic Studies

The [serum potassium] must be performed when:

The patient presented with cardiac arrhythmias,weakness,fatigue and known case of chronic kidney disease as the first step of diagnosis.

The various investigations must be performed in the following order:

Blood pressure(to look for hypoaldosteronism)
Complete blood count
Renal function tests
Urine potassium,sodium and osmolality
Metabolic profile(other electrolytes)
ECG
Bicarbonate level
Serum glucose
Serum Calcium

Depending on the history and results of the above mentioned tests,other tests that can be performed for evaluating the cause of hyperkalemia.

Digoxin level - If the patient is on a digitalis medication
Arterial or venous blood gas
Urinalysis
Serum cortisol and aldosterone levels
Serum uric acid and phosphorus assays
Serum creatinine phosphokinase (CPK) measurements
Urine myoglobin test

Name of Diagnostic Criteria

References

Template:WH Template:WS

@@ Line 10: / Line 10: @@
 === Study of choice ===
-[Name of the investigation] is the gold standard test for the diagnosis of [disease name].
+[Serum potassium] is the gold standard test for the diagnosis of [hyperkalemia].
-OR
+There are two methods to determine serum potassium   :
+* Flame emission spectrophotometry
-The following result of [gold standard test] is confirmatory of [disease name]:
+* Ion-specific electrode (ISE) potentiometry
-* [Result 1]
+ISE potentiometry has two different subtypes: Direct (undiluted) and indirect (diluted).
-* [Result 2]
-OR
+'''Direct ISE''' measures plasma potassium directly from a whole-blood sample and it's not associated with either pseudohyperkalemia.
-[Name of the investigation] must be performed when:
+FES or indirect ISE requires sample dilution before assay   and both are associated with pseudohyperkalemia.
-* The patient presents with [symptom/sign 1], [symptom/sign 2], and [symptom/sign 3].
-* A [name of test] is positive for [sign 1], [sign 2], and [sign 3] in the patient.
-OR
+=== Pseudohyperkalemia ===
+Pseudohyperkalemia is defined when serum potassium concentration exceeds that of plasma   without any symptoms of hyperkalemia.It usually occurs when potassium moves out of cells during blood specimen collection or during centrifugation of the sample.Other causes are thrombocytosis,leukocytosis and erythrocytosis.To rule out pseudohyperkalemia we need to do the following
-[Name of the investigation] is the gold standard test for the diagnosis of [disease name].
+<nowiki>*</nowiki>Repeat the blood sample
-OR
+<nowiki>*</nowiki>Complete blood count to rule out thrombocytosis,erythrocytosis and leukocytosis
-The diagnostic study of choice for [disease name] is [name of the investigation].
+<nowiki>*</nowiki>Measurement of plasma potassium and whole blood potassium
-OR
-There is no single diagnostic study of choice for the diagnosis of [disease name].
-OR
-There is no single diagnostic study of choice for the diagnosis of [disease name], but [disease name] can be diagnosed based on [name of the investigation 1] and [name of the investigation 2].
-OR
-[Disease name] is primarily diagnosed based on the clinical presentation.
-OR
-Investigations:
-* Among the patients who present with clinical signs of [disease name], the [investigation name] is the most specific test for the diagnosis.
-* Among the patients who present with clinical signs of [disease name], the [investigation name] is the most sensitive test for diagnosis.
-* Among the patients who present with clinical signs of [disease name], the [investigation name] is the most efficient test for diagnosis.
-==== The comparison of various diagnostic studies for [disease name] ====
-{|
-|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
-! style="background: #4479BA; color: #FFFFFF; text-align: center;" | Test
-! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Sensitivity
-! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specificity
-|-
-! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 1
-| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
-| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
-|-
-! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 2
-| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
-| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
-|}
-<small> [Name of test with higher sensitivity and specificity] is the preferred investigation based on the sensitivity and specificity</small>
 ===== Diagnostic results =====
-The following finding(s) on performing [investigation name] is(are) confirmatory for [disease name]:
+The finding on performing the diagnostic test that confirms hyperkalemia
-* [Finding 1]
-* [Finding 2]
+<nowiki>*</nowiki>Serum Potassium level more than 5.1 meq/L.
 ===== Sequence of Diagnostic Studies =====
-The [name of investigation] must be performed when:
+The [serum potassium] must be performed when:
-* The patient presented with symptoms/signs 1, 2, and 3 as the first step of diagnosis.
+* The patient presented with cardiac arrhythmias,weakness,fatigue and known case of chronic kidney disease as the first step of diagnosis.
-* A positive [test] is detected in the patient, to confirm the diagnosis.
-OR
 The various investigations must be performed in the following order:
-* [Initial investigation]
+* Blood pressure(to look for hypoaldosteronism)
-* [2nd investigation]
+* Complete blood count
+* Renal function tests
+* Urine potassium,sodium and osmolality
+* Metabolic profile(other electrolytes)
+* ECG
+* Bicarbonate level
+* Serum glucose
+* Serum Calcium
+Depending on the history and results of the above mentioned tests,other tests that can be performed for evaluating the cause of hyperkalemia.
+* Digoxin level - If the patient is on a digitalis medication
+* Arterial or venous blood gas
+* Urinalysis
+* Serum cortisol and aldosterone levels
+* Serum uric acid and phosphorus assays
+* Serum creatinine phosphokinase (CPK) measurements
+* Urine myoglobin test
 === Name of Diagnostic Criteria ===
-'''It is recommended that you include the criteria in a table. Make sure you always cite the source of the content and whether the table has been adapted from another source.'''
-[Disease name] is primarily diagnosed based on clinical presentation. There are no established criteria for the diagnosis of [disease name].
-OR
-There is no single diagnostic study of choice for [disease name], though [disease name] may be diagnosed based on [name of criteria] established by [...].
-OR
-The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
-OR
-The diagnosis of [disease name] is based on the [criteria name] criteria, which includes [criterion 1], [criterion 2], and [criterion 3].
-OR
-[Disease name] may be diagnosed at any time if one or more of the following criteria are met:
-* Criteria 1
-* Criteria 2
-* Criteria 3
-OR
-'''IF there are clear, established diagnostic criteria'''
-The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
-OR
-The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].
-OR
-The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].
-OR
-'''IF there are no established diagnostic criteria'''
-There are no established criteria for the diagnosis of [disease name].
 ==References==