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There are several challenges patients with late-stage lipedema face due to our enlarged limbs and increased concentration of subcutaneous adipose tissue.
Blood Draws & Measurements
Oftentimes, serum potassium levels are falsely elevated because of how our blood is drawn, a situation known as pseudohyperkalemia. This is caused when cellular contents leak out of the cells and result in a high serum potassium level which does not reflect the true level. A tourniquet that is applied too tightly can cause red blood cells to burst, leaking potassium into the specimen. Prolonged use of a tourniquet can also falsely elevate levels.
Repeated clenching of the fist during venipuncture can also cause potassium to leak out of the cells, increasing lab results. While some technicians recommend fist clenching as a method to make veins more visible, this can result in falsely elevated potassium levels and should be avoided. Don et al. (1990) reports that both repeated fist clenching and hand gripping increased the potassium level, whereas no changes in plasma potassium concentrations were found in the arm which was not exercised.
Other measurements which are affected by blood cell rupture, according to Lippi et al. (2006), include alanine aminotransferase (ALT), aspartate aminotransferase (AST), creatinine, creatine kinase (CK), iron, lactate dehydrogenase (LDH), lipase, magnesium, phosphorus and urea, which tend to read higher, and albumin, alkaline phosphatase (ALP), chloride, gamma-glutamyl transferase (GGT), glucose and sodium, which tend to read lower.
Don, B., Sebastian, A., Cheitlin, M., Christiansen, M., & Schambelan, M. (1990, May). Pseudohyperkalemia caused by fist clenching during phlebotomy. The New England Journal of Medicine, 322(18), 1290-1292.
Eldridge, L. (2020, Jul 2). What is a potassium blood test? Very Well Health. https://www.verywellhealth.com/potassium-blood-test-4788327
Feke, T. (2019, Aug 27). How hyperkalemia is diagnosed. Very Well Health. https://www.verywellhealth.com/how-hyperkalemia-is-diagnosed-4160466
Lederer, E. (2020, Apr 09). What causes pseudohyperkalemia (falsely high elevations of serum potassium concentration)? Medscape. https://www.medscape.com/answers/240903-11009/what-causes-pseudohyperkalemia-falsely-high-elevations-of-serum-potassium-concentration
Lippi, G., Salvagno, G., Montagnana, M., Brocco, G., & Guidi, G. (2006). Influence of hemolysis on routine clinical chemistry testing. Clinical Chemistry and Laboratory Medicine, 44(3), 311-316.
Patient-Ordered Blood Testing
Lab tests can be ordered by patients directly through several online labs listed below. Blood is drawn at an approved patient service center, and the test results can be reviewed online. No order is necessary. Currently, New York, New Jersey and Rhode Island state laws prohibit direct-access testing. PLEASE NOTE: lab tests are for your information but are not intended to be a substitute for examination or consultation with a physician or other appropriate healthcare provider.
More About Blood Testing
Six Lab Tests You Need (and How to Order Without a Doctor) – Clean Eating Kitchen
Blood Pressure Measurements
O’Brien (2011) determined that the forearm method use for ambulatory blood pressure measurement is an option in patients with large upper arms and recommended that the patient’s forearm be supported at heart level during measurements (patients are advised to rest their arm on a table during measurement). Leblanc et al. (2019) discovered that in the semi-fowler position (as when partially sitting up in bed), the patient’s forearm could remain unsupported, as this showed the closest representation when compared to an intra-arterial measurement.
Measuring at Wrist and Forearm
O’Brien, E. (2011). What to do when faced with an unmeasurable ambulatory blood pressure? Journal of Hypertension 29, 451–453.
High blood pressure. (2020, Nov 30). Centers for Disease Control and Prevention. https://www.cdc.gov/bloodpressure/measure.htm
Leblanc, M., Auclair, A., Leclerc, J., Bussieres, J., Agharazii, M., Hould, F., … Poirier, P. (2019, Feb). Blood pressure measurement in severely obese patients – Validation of the forearm approach in different arm positions. American Journal of Hypertension 32(2), 175-185.
McFarlane, J. (2012, Dec). Blood pressure measurements in obese patients. Critical Care Nurse, 32(6), 70-73.
Monitoring your blood pressure at home. (2017, Nov 30). American Heart Association. https://www.heart.org/en/health-topics/high-blood-pressure/understanding-blood-pressure-readings/monitoring-your-blood-pressure-at-home
Palatini, P. (2018, Aug 15). Blood pressure measurement in the obese: still a challenging problem. European Society of Cardiology. https://www.drsharma.ca/accuracy-of-forearm-blood-pressure-measurements-in-severe-obesity
Pierin, A., Alavarce, D., Gusmao, J., Halpern, A., & Mion, D. (2004). Blood pressure measurement in obese patients – Comparison between upper arm and forearm measurements. Blood Pressure Monitoring, 9(3), 101-105.
Sharma, A. (2015, Mar 13). Accuracy of forearm blood pressure measurements in severe obesity. Dr. Sharma’s Obesity Notes. https://www.drsharma.ca/accuracy-of-forearm-blood-pressure-measurements-in-severe-obesity
Siddiqui, M., & Calhoun, D. (2019, Feb). Blood pressure measurement challenges in severely obese patients. American Journal of Hypertension, 32(2), 139-140.
Blood Pressure Monitoring
Self-measured blood pressure (SMBP) monitoring is ideal, as you can regularly use a personal blood pressure measuring device at home. There are many blood pressure monitors which are easy and safe to use. Remember to:
Do not eat or drink 30 minutes prior to measuring blood pressure.
Empty your bladder prior to measuring blood pressure.
Sit in a comfortable chair with your back supported for at least 5 minutes before measuring.
Put both feet flat on the ground and do not cross your legs or feet.
Make sure the blood pressure cuff is snug but not too tight.
The cuff should be against bare skin.
No talking while taking the measurement.
Take your blood pressure at the same time every day.
Record your measurement on a log to document trends.
Measuring Blood Pressure Using a Wrist Cuff
Recommended Blood Pressure Wrist Monitors
Blood Pressure Wrist Monitors
Comparison of forearm and upper arm blood pressures – A. Singer, et al