Abstract
Sickle cell disease (SCD) predisposes the patient to recurrent episodes of acute painful hemolytic crisis. Sickle cell nephropathy (SCN) is not uncommon in adult patients, and renal manifestations of SCN include renal ischemia, microinfarcts, renal papillary necrosis, and renal tubular abnormalities with variable clinical presentations. Intravascular hemolysis and reduced glomerular filtration rate with renal tubular dysfunction predispose to true hyperkalemia. Hemolytic crisis can be complicated by sepsis, leading to significant degrees of thrombocytosis, and thrombocytosis is a well-defined cause of pseudohyperkalemia. We describe a 40-year-old African American male patient with sickle cell anemia who exhibited alternating episodes of true hyperkalemia and pseudohyperkalemia, during consecutive hospital admissions. Clearly, true hyperkalemia is a potentially lethal condition. At the same time, the institution of inappropriate and intensive treatment of pseudohyperkalemia leading to severe hypokalemia is also potentially lethal. The need for this caution is most imperative with the recent introduction of the safer and more potent potassium binders, patiromer and sodium zirconium cyclosilicate.
Highlights
Sickle cell disease (SCD) predisposes the patient to recurrent episodes of acute painful hemolytic crisis
We describe a 40-year-old African American male patient with sickle cell anemia who exhibited alternating episodes of true hyperkalemia and pseudohyperkalemia, during consecutive hospital admissions
The patient has remained stable since discharge from the hospital. We believe that this is the first report of adult SCD demonstrating alternating cycles of true hyperkalemia and pseudohyperkalemia at different times, even during one admission
Summary
Alternating and Concurrent True Hyperkalemia and Pseudohyperkalemia in Adult Sickle Cell Disease. Macaulay Amechi Onuigbo, M.D., M.Sc., F.W.A.C.P., F.A.S.N., M.B.A.*, Heng Tan, M.S.I.V., and Sarah E. M.S.I.V. The Robert Larner, M.D. College of Medicine, University of Vermont, Burlington, Vermont, USA
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