Be proactive about a sentinel event.

[Apollyon]

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What happens at your hospital with an elevated K+? Do they repeat it, then report it?

I had it happen once when I was a resident at "Big Time Teaching Hospital". The lab duly repeated the lab study to confirm the K+ of 9. We had an ex post facto root cause analysis, and there was a system change afterward, wherein the lab will call with a prelim, with no hemolysis, but has to be repeated before confirmation. Now, I had a similar episode last night. A patient decompensated, and we clinically recognized his hyperkalemia. Then, the lab reported his K+ as 7.9.

So, be proactive. Check with your lab - if they are not reporting preliminary highs, get them to - consistently, as a written policy. The time to find out is not when the patient arrests!

 

[Cerberus]

Our lab reports prelims, which means I often get phone calls that go like this:
"Dr. Cerberus, it's the lab calling with a critical value on pt X"
me: "ok, what is it?"
Lab: "The potassium is 19"
me: "it's hemolyzed?"
Lab: "I'm not sure"
me: "well if it's not this patient would be dead"

 

[med2UCC]

Our lab reports prelims, which means I often get phone calls that go like this:
"Dr. Cerberus, it's the lab calling with a critical value on pt X"
me: "ok, what is it?"
Lab: "The potassium is 19"
me: "it's hemolyzed?"
Lab: "I'm not sure"
me: "well if it's not this patient would be dead"

With us it's site dependent, but the regional hospital reports the prelim with the note that the sample may be haemolised. Not sure what the outlying sites do, although I do know that one site doesn't treat everything that comes from the emergency department as urgent. I once waited 5 hours for a dilantin level because "that' s not an urgent test". Well, yes it is if your patient with a known seizure disorder is seizing and you'd like to tease out if it's low drug levels or something else. I'm working on change over there. Cheers,
M

 

[Apollyon]

My report came as "not hemolyzed. Repeated."

Prelim reports are better than final that come too late.

 

[NinerNiner999]

Good Call! If my patient is critical (such as yours), I'll send the labs, then also get an ABG with extended electrolyte panel for a quick "prelim" value. iSTAT machines do just as well. 👍

 

[gutonc]

Good Call! If my patient is critical (such as yours), I'll send the labs, then also get an ABG with extended electrolyte panel for a quick "prelim" value. iSTAT machines do just as well. 👍

Except when the person who is supposed to QA the machine only does it for the ABG, not the 'lytes.

We ran into that in the MICU in a code situation when I was an intern. K on the ABG kept coming back at 2, so they kept getting K. Then the stat BMP came back with a K of ~9, not hemolyzed!

Turns out the RTs were charged with doing the QA/QC on the iStat's and since they didn't care about the lytes, they didn't bother to QA them. It had been >1y since they'd been tested for that.