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假性高血钾不同于肾功能衰竭、肾上腺皮质功能不全等疾病所引起的高血钾症。如果临床和心电图无高血钾表现,血浆钾与血清钾相差在0.5mmol/L以上即可诊断为假性高血钾。此类病例国内报道甚少。我院遇到2例真性红细胞增多症患者合并有假性高血钾,报道如下。1 病例介绍 例1,女,56岁。因面部红紫伴头痛1年,于1992年2月25日入院。既往体健。月经生育史正常。体检:BP 18/14 kPa,颊、唇及四肢末端皮肤颜色紫红,HR 8O次/min,律齐,无杂音,双肺呼吸音清晰,肝未及,脾肋下1cm。Hb205g/L,RBC7.0×10~(12)/L,WBC17×10~9/L,BPC544×10~9/L,HCT0.56。血氧饱和度95%。N-ALP积分120。BUN6.9mmol/L。胸片正常。腹部B超除脾稍大外余正常。骨髓增生明显活跃,粒:红=0.94:1,红系增生明显,早幼红2%,中幼红25%,晚幼红19%,成熟红细胞堆聚分布,粒、巨二系增生,比例形态正常。妇科检查正常。多次查血浆钾和血清钾（同一标本）,血浆钾正常,而血清钾>7.8mmol/L。多次查心电图均正常。无高血钾临床表现。诊断为真红并假性高血钾。未按高血钾处理,予三尖杉酯碱静滴。随着全血下降至正常血清钾降至正常。病人1992年4月20日真红临床缓解出院。
Pseudo-hyperkalemia is different from renal failure, adrenal insufficiency and other diseases caused by hyperkalemia. If the clinical and electrocardiogram without hyperkalemia, plasma potassium and serum potassium difference in more than 0.5mmol / L can be diagnosed as pseudo-hyperkalemia. Domestic cases rarely reported. 2 cases of polycythemia vera encountered in our hospital with false hyperkalemia, reported as follows. A case introduction example 1, female, 56 years old. Due to facial purple with headache for 1 year, on February 25, 1992 admission. Past physical health. Menstrual birth history is normal. Physical examination: BP 18/14 kPa, cheek, lip and extremity skin color purple, HR 8O times / min, law Qi, no noise, clear lung breath sounds, liver and spleen, rib 1cm. Hb205g / L, RBC7.0 × 10-12 / L, WBC17 × 10 ~ 9/L, BPC544 × 10 ~ 9/L, HCT0.56. Oxygen saturation of 95%. N-ALP points 120. BUN 6.9mmol / L. Normal chest X-ray. Abdominal B-spleen slightly larger than normal. Myeloid hyperplasia was obviously active, granule: red = 0.94: 1, erythroid hyperplasia obviously, young erythroid 2%, young red 25%, late young red 19%, mature erythrocyte accumulation and distribution, Normal shape. Gynecological examination is normal. Check potassium and serum potassium many times (the same specimen), plasma potassium normal, and serum potassium> 7.8mmol / L. Multiple check ECG are normal. No hyperkalemia clinical manifestations. True red and false hyperkalemia. Not treated by hyperkalemia, to harringtonine intravenous infusion. As whole blood drops to normal serum potassium drops to normal. April 20, 1992 patients really red clinical discharge.