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Contributors: Scott Echternacht MD, Benjamin L. Mazer MD, MBA, Michael W. Winter MD
Other Resources UpToDate PubMed


Pseudohyperkalemia is a laboratory artifact that can show a clinically nonsignificant hyperkalemia due to a variety of causes, including hematologic abnormalities, errors in blood sample collection, and complications of serum potassium measurement. Rarely, pseudohyperkalemia can present in a familial form.

Hematologic abnormalities are a common cause of pseudohyperkalemia and include significant leukocytosis or thrombocytosis. Pseudohyperkalemia is also often due to errors in blood sample collection, such as potassium release secondary to a tourniquet or hemolysis within the test tube. Pseudohyperkalemia can be a complication of serum potassium measurement due to excess potassium release from the clot that forms during the separation of serum. Familial pseudohyperkalemia is caused by hereditary xerocytosis. This defect causes red cell membrane abnormalities that increase cellular potassium leak within collection tubes. Plasma potassium measurement, which is becoming more common, is not often affected by these spurious elevations.


E87.5 – Hyperkalemia

14140009 – Hyperkalemia

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Differential Diagnosis & Pitfalls

Increased potassium release from cells:
  • Metabolic acidosis (other than organic acidosis due to Lactic acidosis or Diabetic ketoacidosis)
  • Insulin deficiency
  • Hyperglycemia
  • Hyperosmolality
  • Any cause of increased tissue breakdown (eg, trauma, tumor lysis syndrome, severe accidental Hypothermia, Rhabdomyolysis)
  • Beta blockers
  • Exercise
  • Hyperkalemic periodic paralysis
  • Digitalis toxicity
  • Red blood cell transfusion
  • Administration of succinylcholine to patients with burns, extensive trauma, prolonged immobilization, chronic infection, or neuromuscular disease
  • Administration of arginine hydrochloride
  • Use of drugs that activate ATP-dependent potassium channels in cell membranes such as calcineurin inhibitors (eg, cyclosporine, tacrolimus), diazoxide, minoxidil, volatile anesthetics (eg, isoflurane)
Reduced urinary potassium excretion:
  • Reduced aldosterone secretion
  • Reduced response to aldosterone (aldosterone resistance):
    • Administration of potassium-sparing diuretics
    • Voltage-dependent Distal renal tubular acidosis
    • Hereditary pseudohypoaldosteronism
  • Reduced distal sodium and water delivery
    • Effective arterial blood volume depletion
    • Excess dietary sodium intake
  • Acute kidney injury and Chronic kidney disease (in which one of the above factors are present)
  • Selective impairment in potassium secretion
  • Hereditary pseudohypoaldosteronism (Gordon syndrome)
  • Uretero jejunostomy

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Last Reviewed:05/08/2019
Last Updated:01/23/2022
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A medical illustration showing key findings of Pseudohyperkalemia : Leukocytosis, Thrombocytosis
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