Medical professionals: Should I see another doctor? How urgently?
November 19, 2020 8:53 AM   Subscribe

I have been having stomach pain and random back pain associated with that stomach pain for about a week. It has improved in the last few days, though not due to any particular cause as far as I can identify. In many ways, it feels like trapped gas, and often I feel relief after passing gas or burping. I went to see a doctor, as my family has a history of kidney stones and I suspect maybe this was the start of one. My blood test results revealed very high potassium and slightly high uric acid. The doctor said the potassium result is very high (7.1 mval/l) and can be very bad for my heart, but said to just avoid eating potassium for one week and we'll test the blood again. Is this all I should be doing?

I'm in Germany, which is not my home country, and I don't have a "family doctor" so I had my insurance company make me an appointment with whatever doctor was available in my town and also spoke English. The doctor did blood tests and urine tests and there were two out-of-normal range results: 1. potassium level of 7.1 mval/L (normal range 3-5) and uric acid of 7.4 mg/dl (normal 3.4-7).

I had blood tests 2 months ago because my stomach was bothering me (acid-reflux type issues, which are common in my family anyway), and throughout the last year I've been losing weight without explanation. My potassium levels at that time were normal. It doesn't look like they tested uric acid in those prior results.

Anyway, I'm concerned because when looking up these potassium levels, they aren't just "a little high," but some search results indicate they are dangerously high and that I should perhaps be on a medication to lower them (unless the blood test results are faulty). I'm in my 20's and otherwise healthy, but my family does have a history of heart problems so of course it concerns me if very high potassium can cause heart issues. The doctor didn't seem this worried and said to wait a week. She asked me about my diet and said she thinks I'm eating too much meat and potassium. I don't think so - perhaps I've had a bit higher potassium lately because of my smoothies in the morning, but it's like 1 banana a day and a few berries. As far as my meat intake, I eat only chicken and turkey (no red meats) and not in huge quantities. I haven't changed my diet drastically enough to result in massive changes in my potassium levels, it seems.

As I mentioned before, in the last year, I've also been losing weight despite still seemingly eating a lot (I have always had a high metabolism). I've brought this up to the doctor I saw two months ago, but she wasn't too worried because my blood tests looked normal. With these new results, I suspect there is something else going on.

As far as current symptoms, I largely felt okay yesterday and before this doctor appointment today. I can be an anxious person, so now after these results I'm not feeling good, but I know that is my anxiety acting up.

So: Should I try and get an appointment with another doctor? Should it be a generalist or specialist? How urgently should I do this? Anything else I should do in the meantime?
posted by anonymous to Health & Fitness (10 answers total) 1 user marked this as a favorite
Is there an advice nurse you can call?
posted by aniola at 9:05 AM on November 19 [1 favorite]

I'd wait for the second blood draw/test, you can get false readings of high potassium due to anything from a badly done blood draw to just being dehydrated. I suspect that is why your doctor is wanting to wait to confirm the reading. I would however make sure to keep pushing & following up to make sure you do get a clear answer to your questions. I would push to see another doctor if I started to exhibit any other symptoms though.

If you are losing weight for whatever reason, that can cause gallstones. Except for your potassium levels your symptoms sound a lot like mine did when I got gallstones from losing weight.
posted by wwax at 9:14 AM on November 19

Where are you in Germany? What kind of insurance do you have? You can pm me if you need help with finding a doctor.
posted by melamakarona at 9:43 AM on November 19

This sounds kind of scary actually. I'd suggest writing down your main symptoms (including the UNEXPLAINED weight loss over the past year -- include the amount of weight and timeline if you can), stomach problem 2 months ago, and this latest situation. Unexplained abdominal pain can be a sign of a lot of things, some of them deadly.

In the mean time make sure you're not dehydrated. I really don't want to give you medical advice since I am NOT a doctor at all but my impression is that it's the balance of potassium to sodium that is important, so if you eat an extremely low sodium diet, mention that to the doctor and maybe include a bit of ordinary salt with your food.
posted by heatherlogan at 9:48 AM on November 19

I don’t know about Germany, but in the US, at least in areas where I have practiced, a K+ of >7 without clear explanation (CKD, for example) is considered a “panic” value by labs and would prompt a phone call or electronic message to the ordering physician. While hemolysis can cause this, those samples with K+ level above this range are often visibly hemolyzed.

The suggestion to come back in a week for a re-test strikes me as an excessively casual approach (read incompetence/malpractice), leaving aside all your other complaints. So, yes, get another test and see another doctor asap.
posted by sudogeek at 10:49 AM on November 19 [9 favorites]

I don't know how they do things in Germany
but in USA potassium that high is considered a medical emergency and should prompt a visit to ER for immediate repeat labs. I am frankly stunned that the doctor is so casual about it.

It could be due to hemolysis but immediate recheck is called for.

I am not your doctor and this is not medical advice, etc; if a friend of mine mention this to me I would personally drive that person to the nearest ER.
posted by Pantalaimon at 11:16 AM on November 19 [3 favorites]

Piggybacking on sudogeek above - hemolyzed means that some of the blood in the test tube has had its cell walls broken so that when the tube is spun down in the lab to separate the serum from the cells (the serum is what is tested) it appears pink or red from the broken cells. Some of the potassium that is IN the cell is thus released into the serum and falsely elevates the serum potassium level. This is often the result of the blood drawing technique and not something you as a patient can prevent. However, the presence of hemolysis is boldly noted on the lab result precisely because it can raise the potassium level.

I agree that a K+ of above 7 is extremely concerning outside of known and medically followed kidney disease, and occasional kidney stones do not count. You should return to the doctor for a repeat test ASAP, ask if your previous test was hemolyzed, and if it wasn't consider a renal specialist. And the potassium level needs to be reduced. Avoid potatoes, bananas, raisins, orange juice, beans, lentils and other high-potassium foods until you can get a handle on your situation. There are medications to reduce or "bind" potassium, but they can only be dispensed by a dr. in the US. I think you need more comprehensive, better medical advice. I would suggest at the very least an ultrasound to see if there is a stone present, but unless there is ureter obstruction and typically excruciating pain, that would not explain the potassium. Your unintentional weight loss is another issue requiring investigation, but you must reduce the potassium first. If you can't get an urgent appointment, like today or tomorrow, you might need an urgent or ER visit. If the pain worsens that would tip me to recommend the ER. Good luck, I know it must be scary to be in another country without local medical care that you trust.
posted by citygirl at 11:20 AM on November 19

From the OP:
Thank you everyone for your comments! I was able to see a doctor today (I posted this yesterday but due to anonymous approval process it took a bit). The doctor seemed very competent and extremely thorough in the examination. We redrew blood and will have the test result in the morning. They did an ultrasound as well and everything looked normal. The pain has been mostly non-existent today, but I'm continuing to monitoring in case it returns, and still avoiding potassium until we verify yesterday's result was false. I'm on a ppi for a couple weeks to see if it helps with some of my acid-related digestive issues, and am supposed to continue monitoring symptoms otherwise. I also have a referral to a specialist for follow-up. In general, everything was handled much better and I'm glad I found a doctor who took my concerns (and is continuing to take them) seriously. But thanks everyone for your quick responses and guidance.
posted by loup (staff) at 11:43 AM on November 19 [4 favorites]

Potassium levels that high (if real and not due to hemolysis) are an emergency. In my patients, values like that get redrawn stat, an ECG is performed to look for signs of potassium-related cardiac toxicity and the patient is monitored closely before a second result is available (that I personally call the lab for). I would never allow a patient with such a lab value to go home.

I am frankly surprised the second doc was happy to wait for the follow-up until the next day. Can you phone the office and ask that they call the lab to check? Especially for potassium, the lab analysis should be performed promptly anyway since "old" samples can be unreliable.

I have definitely had patients where this kind of level turned out to be a false alarm (ie, the second result was in the normal range) but I'd still follow up.
posted by M. at 12:10 PM on November 19 [2 favorites]

I'm glad you got some more attention. My husband has various health problems, and a potassium level measured at 6.5 recently resulted in him receiving a call from his GP telling him to get someone else to drive him to the emergency department immediately so it could be re-checked. He did this, and the repeat level was much lower. High potassium (if that is what it really is) is not to be messed with and can kill you quickly.
posted by altolinguistic at 11:01 AM on November 20

« Older How to get over myself   |   COVID and Domestic Travel in Canada Newer »

You are not logged in, either login or create an account to post comments