Increase in Serum Potassium Levels After Refrigerated Storage: A Component of Blood Clot Contaminates the Serum Layer Over the Separator Gel

Objectives: The aim of this study was to determine the cause of elevated serum potassium levels when blood collection tubes containing separating gel are stored under refrigeration. Methods: Fifty-seven hospitalized patients and 11 healthy volunteers were recruited. Venous blood samples were obtained using Insepac II, Neotube, and Venoject® II, without anticoagulant. After centrifugation under different processing conditions, the capped tubes were stored at 4°C without aliquoting, and serum potassium levels were measured for up to 14 days. Correlation between the increase in potassium levels and blood cell counts was assessed. Furthermore, serum was replaced with a saline solution and potassium levels were determined after refrigeration. Results: Refrigerated samples stored in Insepac II tubes had significantly higher serum potassium levels on day 14 than on the day of blood collection. The increase in serum potassium levels was positively correlated with the number of red blood cells, but not white blood cells and platelets in venous blood. Furthermore, potassium levels were elevated when serum was replaced with a saline solution. Using Venoject II, which has a larger tube diameter and thicker separating gel than those of Insepac II and Neotube, did not increase serum potassium levels after storage. Increase in the serum potassium level was markedly suppressed by centrifugation at 2330 g for 15 minutes relative to other processing conditions. Conclusions: Potassium levels increase when serum is refrigerated in collection tubes containing separating gel. This can be attributed to contamination of the serum layer by blood cell components beyond the separating gel.

ΔHR/ΔWR derived from CPET; A novel predictor of 'off' symptom in Parkinson's disease

INTRODUCTION

Chronotropic incompetence (CI) is broadly defined as the inability of the heart to increase its rate commensurate with increased activity. In this study, we tried to clarify the link between CI and UPDRS part II (off-on), which was calculated by subtracting part II (on) from part II (off), in patients with Parkinson's disease (PD).

METHODS

Thirty-six hospitalized patients were examined by using cardiopulmonary exercise testing (CPET) for exercise tolerance (ΔVO2/ΔWR and peak VO2/W) and the presence of CI (ΔHR/ΔWR), and using electrocardiogram for heart rate variability.

RESULTS

We originally divided the patients into three groups; Group I (ΔHR/ΔWR x100 <15) (N = 3), Group II (15≥, <60) (N = 28), Group III (>60) (N = 5). Since Group I and III were significantly smaller and older than Group II, we focused and divided into two groups; Group II CI (+), the PD patients with CI (15≤ ΔHR/ΔWR x100 <35), and Group II CI (-), those patients without that (35≤ ΔHR/ΔWR x100 <60). ΔVO2/ΔWR and peak VO2/W in CI (+) patients was lower than CI (-) (P = 0.022 and P = 0.096, respectively). HF power (parasympathetic activity) tends to be decreased, whereas LF/HF ratio (sympathetic activity) was increased in CI (+) patients as compared with CI (-). The UPDRS part II (off-on) of CI (+) patients was significantly higher than CI (-) (P = 0.023).

CONCLUSIONS

In PD patients, the difference between 'on' and 'off' in activities of daily living might be predicted by using ΔHR/ΔWR x100 obtained from CPET as an index.

Persistent urticaria--urticarial reaction caused by late phase reaction?

In ordinary urticaria, individual lesions disappear within 24 hours. We encountered 3 patients who showed urticarial reactions lasting more than 24 hours. In all patients, skin biopsy revealed interstitial dermal edema and a perivascular infiltration predominated by eosinophils, without immunoglobulins or complement deposition, or endothelial fibrinoid degeneration. Their eosinophil counts and serum complement levels were within normal range. No proteinurea or joint pain was observed. They could not be controlled by any medications except for glucocorticoid. These findings indicate our cases are not ordinary urticaria, urticarial reaction accompanied by eosinophilia, urticarial vasculitis or delayed pressure urticaria. We recognize such urticarial reaction as a different clinical entity from the usual urticaria, and we speculate that this condition is caused by late phase reaction because of the clinical course and eosinophil infiltrations.

Churg-Strauss syndrome with renal involvement: a case report

We report a case of Churg-Strauss syndrome with renal involvement. A 51-year-old woman was admitted to our hospital in April of 1999 complaining of abdominal pain and severe diarrhea followed by multiple purpura on both legs. A diagnosis of Churg-Strauss syndrome was made on the basis of the presence of preceding asthma, eosinophilia, increased IgE, and the histological findings of a biopsy taken from the purpura. Creatinine clearance level at admission was low (43.3 ml/min) and urinalysis revealed proteinuria and microscopic hematuria. These abnormalities were improved with systemic steroid therapy. Renal involvement seems to be more common than previously reported in Churg-Strauss syndrome.