Errors in potassium measurement: A laboratory perspective for the clinician

Errors in potassium measurement can cause pseudohyperkalemia, where serum potassium is falsely elevated. Usually, these are recognized either by the laboratory or the clinician. However, the same factors that cause pseudohyperkalemia can mask hypokalemia by pushing measured values into the reference interval. These cases require a high-index of suspicion by the clinician as they cannot be easily identified in the laboratory. This article discusses the causes and mechanisms of spuriously elevated potassium, and current recommendations to minimize those factors. "Reverse" pseudohyperkalemia and the role of correction factors are also discussed. Relevant articles were identified by a literature search performed on PubMed using the terms "pseudohyperkalemia," "reverse pseudohyperkalemia," "factitious hyperkalemia," "spurious hyperkalemia," and "masked hypokalemia."