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Question: potassium levels


 mlpk - Fri Aug 20, 2010 9:54 pm

I have just had labs come back and my doctor is baffled. It appears that intra cellularly my potassium levels are low yet extracellularly my levels are at 5.7--i have been tested 3 times and all my levels are consistently high (5.2-5.7). What does this mean? How can I fix it? what tests would you feel should be done? (I was recently diagnosed (a year ago) with hashimoto's thyroditis and adrenal fatigue. I am still recovering 2 years later from 24/7 headaches and migraines which we believe are the after effects of spinal meningitis 2 years ago)
 Dr.M.Aroon kamath - Fri Aug 27, 2010 1:41 am

User avatar Hi,
It is not clear how it came to be known that your intracellular Potassium(K+) levels are low. These are not measured routinely. Are your renal functions OK?. What about other serum electrolytes (esp, bicarbonate)? What is the blood pH? What is the serum osmolality?

Most of the total body K+ is intracellular. This pool acts as a buffer to prevent sudden, wide fluctuations of the serum levels which can have deleterious effects on the heart. Intracellular shift of the serum K+ and renal excretion of potassium under aldosterone influence are the chief ways the body gets rid of excess serum K+. This mechanism is well developed in humans. However, there is no well developed renal mechanism for conservation of K+.

Normal adult values for serum K+ range from 3.5 to 5.5 mmol/L. Serum K+ concentrations may not be an accurate indicator of total body stores, as intracellular K+ accounts for 98% of total body amount.Serum K+ levels below 3.5 and above 5.5 mmol/L have traditionally been labeled as hypokalemia and hyperkalemia, respectively.Serum K+ above 6.5 mEq/L is associated with significant morbidity and mortality and should be handled as an emergency.

In routine clinical situations, whenever high values for serum K+ are encountered, the technique of blood specimen collection needs to be first looked into. 'Pseudohyperkalemia' is an in vitro phenomenon (i.e., the in vivo serum K+ is normal). This is caused by the release of K+ from cellular elements of blood during the process of clotting and, less commonly, by the release of K+ from ischemic muscle cells due to tight tourniquet or hand/arm exercise during the procedure. If the latter is suspected, blood should be drawn in a proper manner again and serum K+ repeated. If the former is suspected, the platelet and white cell counts should be checked, and serum should be inspected for significant hemolysis (hemolized sample). Hyperkalemia occurs when there is thrombocytosis (platelet count greater than 600,000), leukocytosis (WBC greater than 200,000) or significant hemolysis (serum hemoglobin greater than 1.5 g/dl). In cases of pseudohyperkalemia, the plasma K+ (unclotted blood), as opposed to serum K+, will be normal.

Hemolysis may occur during sample collection due to,
- rapid aspiration of blood through a narrow-gauge needle,and
- excessive agitation of blood samples.

To prevent false results, phlebotomy personnel should not rapidly aspirate blood through a narrow-gauge needle or excessively agitate blood samples.

Hyperkalemia associated with normal total body K+ is caused by the shifts of K+ out of the cell and is commonly seen in acidemia, sudden increases in plasma osmolality, massive tissue breakdown and, in very rare circumstances, adrenergic blockade and hyperkalemic periodic paralysis.

Gordon's syndrome or Familial hyperkalemia and hypertension (FHH; pseudohypoaldosteronism type II) is an autosomal dominant disorder featuring hyperkalemia, hypertension, and low renin. Hypercalciuria accompanies hyperkalemia, and both precede hypertension. The mean time between detection of hyperkalemia and appearance of hypertension was seen to be 13 yrs in some studies.

Several HIV-1 proteins have been shown to perturb membrane permeability and ion transport. Unexplained hyperkalemia persisting despite normal cortisol response to ACTH may represent hyporeninemic hypoaldosteronism, which has been described in hospitalized patients with HIV disease. Hyporeninemic hypoaldosteronism may occur with several other conditions as well.

Chewing tobacco contains a significant amount of potassium. A case of severe hyperkalemia in a patient undergoing chronic hemodialysis due to tobacco chewing has been reported.
[Fan K, Leehey DJ. Orange juice-induced hyperkalemia in a diabetic patient with chronic renal failure. Diabetes Care. 1996 Dec;19(12):1457-8].

Without much by way of history to go by and with lack of details regarding other laboratory tests, i can't be more specific. As you indicate that you had meningitis in the recent past (2008), you need to have your serum osmolality checked. You may consider discussing with your doctor about being referred to a neurologist for a consultation.
I hope this information is of help.
Best wishes!

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