Pseudohyperkalemia in Horses with Rhabdomyolysis Reported by an Enzymatic Chemistry Analyzer.

OBJECTIVE To investigate pseudohyperkalemia occurring in horses experiencing rhabdomyolysis when serum chemistry profiles are run on an VetScan VS2 analyzer (Abaxis). ANIMALS 18 horses with rhabdomyolysis (creatine kinase [CK] > 1,000 U/L). METHODS In 3 horses with serum CK activities > 5,800 U/L and persistent serum potassium concentrations of > 8.5 mmol/L (VetScan VS2), potassium concentrations were reevaluated with either i-STAT Alinity Base Station (Abbott), Catalyst (Idexx), or Cobas c501 (Roche) ion-specific analyzers. Paired serum samples from 15 additional horses (median serum CK activity, 7,601 U/L; range, 1,134 to 192,447 U/L) were analyzed on both VetScan VS2 and Cobas c501 machines. Serum potassium concentrations were compared between the VetScan VS2 and ion-specific analyzers by Bland-Altman and Wilcoxon ranked tests and correlated to log(10) CK activity via Pearson correlation. RESULTS Serum potassium concentrations were significantly higher on the VetScan VS2 (6.7 +/- 1.6 mmol/L) versus the ion-specific analyzers (4.0 +/- 1.1 mmol/L; P < .0001), with high bias shown in Bland-Altman analysis (43.1 +/- 27.9). Potassium concentrations positively correlated with log(10) CK activity with the VetScan VS2 (R-2 = 0.51; P = .003) but not the Cobas (R-2 = 0.09; P = .3) analyzer. CLINICAL RELEVANCE An alternate analyzer to the VetScan VS2 should be used to evaluate serum potassium concentrations in horses with rhabdomyolysis because the VetScan VS2 methodology uses lactate dehydrogenase, which increases in serum with rhabdomyolysis and falsely elevates potassium concentrations.