Laboratoriumgeneeskunde Nummer 5 , pp. 38-45
okt 2020, jaargang 3
Laboratoriumgeneeskunde Nr. 5 , pp. 38-45
okt 2020, jr. 3
Wetenschap

Welke extreme laboratoriumresultaten kunnen patiënten nog overleven?

Lees online

Beoordeling van laboratoriummetingen vereist inzicht in de klinische plausibiliteit van de resultaten en of de waarden, zeker de meer extreme, überhaupt met het leven verenigbaar zijn. Om meer duidelijkheid te krijgen over welke waarden bij levende, niet-moribunde patiënten nog kunnen voorkomen zijn voor een tiental analytes (natrium, kalium, chloride, magnesium, fosfaat, totaal calcium, geïoniseerd calcium, pH en hemoglobine) de meest extreme resultaten uitgezocht over de jaren 2014-2018 in de database van een klinisch chemisch hematologisch laboratorium van een grote perifere opleidingskliniek. Om tot reële waarden te komen die nog met het leven verenigbaar bleken te zijn, moesten de gemeten waarden bevestigd zijn middels meerdere analyses, en moesten de patiënten na waarneming van het betreffende extreme resultaat nog tenminste 28 dagen leven. Per bepaling zijn de vijf hoogste en laagste resultaten opgezocht. Om enig inzicht te krijgen hoe betreffende extreme waarden kunnen ontstaan en met welke symptomen deze gepaard gaan is van deze patiënten de casuïstiek nagetrokken.

Literatuurlijst

  1. De Bruyn KMT, van der Horst M, van Ingen HE, et al. Richtlijn vrijgave van laboratoriumuitslagen. Ned Tijdschr Klin Chem Labgeneesk 2016;41:1-26.
  2. De Luca LA, Menani JV, Johnson AK. Neurobiology of Body Fluid Homeostasis: Transduction and Integration. Boca Raton (FL): CRC Press/Taylor & Francis; 2014.
  3. Wang YG, Zhou JC, Wu KS. High 28-day mortality in critically ill patients with sepsis and concomitant active cancer. J Int Med Res 2018;46:5030-9.
  4. Visiedocument Klinische Chemie en Laboratoriumgeneeskunde 2025. 2018.
  5. Hammerling JA. A review of medical errors in laboratory diagnostics and where we are today. Lab Med 2012;43:41-4.
  6. Ten Bos LM, Veenstra TC, Westerhof BD, et al. A case of extreme hypokalaemia. Neth J Med 2016;74:406-9.
  7. Scheuren A, Jürgensen JS, Krüger A, et al. Extreme hyponatremia of 87 mmol/l without neurologic complications in a severely hypovolemic patient. Am J Med 2000;109:679-81.
  8. Abelian A, Ghinescu CE. Premature baby with extreme hyponatraemia (95 mmol per litre): a case report. BMC Pediatr 2015;15:121.
  9. Yessayan L, Yee J, Frinak S, et al. Treatment of severe hyponatremia in patients with kidney failure: role of continuous venovenous hemofiltration with low-sodium replacement fluid. Am J Kidney Dis 2014;64:305-10.
  10. Borrego DRR, Imaz Roncero A, López-Herce CJ, et al. Severe hypernatremia: survival without neurologic sequelae. An Pediatr (Barc) 2003;58:376-80.
  11. Arambewela MH, Somasundaram NP, Garusinghe C. Extreme hypernatremia as a probable cause of fatal arrhythmia: a case report. J Med Case Rep 2016;10:272.
  12. Ofran Y, Lavi D, Opher D, et al. Fatal voluntary salt intake resulting in the highest ever documented sodium plasma level in adults (255 mmol L-1): a disorder linked to female gender and psychiatric disorders. J Intern Med 2004;256:525-8.
  13. Akinci B, Celik A, Saygili F, et al. A case of gitelman’s syndrome presenting with extreme hypokalaemia and paralysis. Exp Clin Endocrinol Diabetes 2009;117:69-71.
  14. Vogt W, Oesterle B. Extreme results in electrolyte determination. Wien Klin Wochenschr Suppl 1992;192:21-7.
  15. Kallen RJ, Rieger CHL, Cohen HS, et al. Near-fatal hyperkalemia due to ingestion of salt substitute by an infant. JAMA 1976;235:2125-6.
  16. Bosse GM, Platt MA, Anderson SD, et al. Acute oral potassium overdose: the role of hemodialysis. J Med Toxicol 2011;7:52-6.
  17. Horisberger T, Fischer JE, Waldvogel K. Long-term outcome of an infant resuscitated from iatrogenic potassium intoxication with a serum level of 17.7 mmol/l. Eur J Pediatr 2004;163:48-9.
  18. Niewiński G, Korta T, Debowska M, et al. Cardiac arrest in chronic metabolic alkalosis due to sodium bicarbonate abuse. Anestezjol Intens Ter 2008;40:173-7.
  19. Niederstadt C, Kurowski V, Djonlagic H. Severe metabolic alkalosis with a consciousness disorder. Dtsch Med Wochenschr 1996;121:978-82.
  20. Llitjos JF, Mongardon N, Crabol Y, et al. Extreme metabolic alkalosis: excessive alkali intake due to ulcerative disease. Nephrology (Carlton) 2013;18:844.
  21. Sotos JF, Cutler EA, Finkel MA, et al. Hypocalcemic coma following two pediatric phosphate enemas. Pediatrics 1977;60:305-7.
  22. Bergkamp FJ, van Berkel AM, van der Linden PW, et al. Unexpected prolonged extreme hypocalcaemia and an inadequate PTH response in a patient with metastatic breast carcinoma. Neth J Med 2003;61:371-5.
  23. Kabisch H, Niggemann B, Winkler K. Extreme hyperphosphatemia with hypocalcemia within the scope of cell lysis syndrome in a child with T-ALL. Onkologie 1989;12:64-8.
  24. Ranganath L, Jamal H, Jones L, et al. Value of assessing parathyroid hormone-like activity in a case of extreme hypercalcaemia. J Clin Pathol 1998;51:257-8.
  25. Marienhagen K, Due J, Hanssen TA, et al. Surviving extreme hypercalcaemia - a case report and review of the literature. J Intern Med 2005;258:86-9.
  26. Weng YM, Chen SY, Chen HC, et al. Hypermagnesemia in a constipated female. J Emerg Med 2013;44:e57-60.
  27. Tan AC, Janssens PM, Meijer JW, et al. Hypercalcemia due to adult T-cell lymphoma in a man from Surinam. Ned Tijdschr Geneeskd 2001;145:370-4.
  28. Semb S, Helgstrand F, Hjorne F, et al. Persistent severe hypomagnesemia caused by proton pump inhibitor resolved after laparoscopic fundoplication. World J Gastroenterol 2017;23:6907-10.
  29. Willows J, Al Badi M, Richardson C, et al. Case Report: investigation and molecular genetic diagnosis of familial hypomagnesaemia. F1000Res 2019;8:666.
  30. Gladziwa U, Schwarz R, Gitter AH, et al. Chronic hypokalaemia of adults: gitelman‘s syndrome is frequent but classical bartter‘s syndrome is rare. Nephrol Dial Transplant 1995;10:1607-13.
  31. Onishi S, Yoshino S. Cathartic-induced fatal hypermagnesemia in the elderly. Intern Med 2006;45:207-10.
  32. Kala J, Abudayyeh A. Magnesium: an overlooked electrolyte. J Emerg Med 2017;52:741-3.
  33. Van Dissel JT, Gerritsen HJ, Meinders AE. Severe hypophosphatemia in a patient with anorexia nervosa during oral feeding. Miner Electrolyte Metab 1992;18:365-9.
  34. Cubillos Celis MP, Nannig PM. Hypophosphatemia in preterm infants: a bimodal disorder. Rev Chil Pediatr 2018;89:10-7.
  35. Hsu HJ, Wu M-S. Extreme hyperphosphatemia and hypocalcemic coma associated with phosphate enema. Intern Med 2008;47:643-6.
  36. Opdahl H. Survival put to the acid test: extreme arterial blood acidosis (pH 6.33) after near drowning. Crit Care Med 1997;25:1431-6.
  37. Bey TA, Walter FG, Gibly RL, et al. Severe metabolic and survival after ethylene glycol poisoning in a patient with an arterial pH of 6.58. Vet Hum Toxicol 2002;44:167–8.
  38. Willcox N, Oakley P. Survival with an arterial pH of 6.57 following major trauma with exsanguinating haemorrhage associated with traumatic amputation. Resuscitation 2002;53:217-21.
  39. Collinet P, Subtil D, Puech F, et al. Successful treatment of extremely severe fetal anemia due to Kell alloimmunization. Obstet Gynecol 2002;100:1102-5.
  40. Ng KO, Chow LH, Wang CC, et al. Successful management of massive blood loss to extremely low hemoglobin in an elderly woman receiving spinal surgery. Acta Anaesthesiol Sin 2000;38:89-92.
  41. De Araújo Azi LMT, Lopes FM, Garcia LV. Postoperative management of severe acute anemia in a Jehovah’s Witness. Transfusion 2014;54:1153-7.
  42. Yip R. Significance of an abnormally low or high hemoglobin concentration during pregnancy: special consideration of iron nutrition. Am J Clin Nutr 2000;72:272S-279S.
  43. Beall CM, Brittenham GM, Macuaga F, et al. Variation in hemoglobin concentration among samples of high‐altitude natives in the Andes and the Himalayas. Am J Hum Biol 1990;2:639-51.
  44. Tewari SC, Jayaswal R, Kasthuri AS, et al. Excessive polycythaemia of high altitude. Pulmonary function studies including carbon monoxide diffusion capacity. J Assoc Physicians India 1991;39:453-5.
  45. Holley AD, Green S, Davoren P. Extreme hypernatraemia: a case report and brief review. Crit Care Resusc 2007;9:55-8.
  46. Das SK, Afroze F, Ahmed T, et al. Extreme hypernatremic dehydration due to potential sodium intoxication: consequences and management for an infant with diarrhea at an urban intensive care unit in Bangladesh: A case report. J Med Case Rep 2015;9:124.
  47. Marshall W, Lapsley M, Day A. Clinical Chemistry 8th edition. Elsevier; 2016.
  48. Hwang KS, Kim GH. Thiazide-induced hyponatremia. Electrolyte Blood Press 2010;8:51-7.
  49. Kalksma R, Leemhuis MP. Hyponatriëmie bij gebruik van thiazidediuretica: let op combinaties van geneesmiddelen die dit effect versterken. Ned Tijdschr Geneeskd 2002;146:1521-5.
  50. Fuzaylova I, Lam C, Talreja O, et al. Sacubitril/Valsartan (Entresto®)-induced hyponatremia. J Pharm Pract 2019;897190019828915.
  51. Raebel MA. Hyperkalemia associated with use of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers. Cardiovasc Ther 2012;30:e156-66.
  52. Kotchen TA. Antihypertensive therapy-associated hypokalemia and hyperkalemia: clinical implications. Hypertension 2012;59:906-7.
  53. Florentin M. Proton pump inhibitor-induced hypomagnesemia: a new challenge. World J Nephrol 2012;1:151-4.
  54. Huang CL, Kuo E. Mechanism of hypokalemia in magnesium deficiency. J Am Soc Nephrol 2007;18:2649-52.
  55. Neki NS. Hyperthyroid hypokalemic periodic paralysis. Pak J Med Sci 2016;32:1051-2.
  56. Durward A, Skellett S, Mayer A, et al. The value of the chloride:sodium ratio in differentiating the aetiology of metabolic acidosis. Intensive Care Med 2001;27:828-35.
  57. Funk GC, Zauner C, Bauer E, et al. Compensatory hypochloraemic alkalosis in diabetic ketoacidosis. Diabetologia 2003;46:871-3.
  58. Oberleithner H, Guggino W, Giebisch G. The effect of furosemide on luminal sodium, chloride and potassium transport in the early distal tubule of Amphiuma kidney. Effects of potassium adaptation. Pflugers Arch 1983;396:27-33.
  59. Enna SH, Bylund DB. Aldosterone antagonists. xPharm: The comprehensive pharmacology reference. Elsevier; 2008.
  60. Herrmann JB, Kirsten E, Krakauer JS. Hypercalcemic syndrome associated with androgenic and estrogenic therapy. J Clin Endocrinol Metab 1949;1:1-12.
  61. Shima F, Ishida Y, Yoshida R, et al. Severe hypocalcemia in a patient with protein-losing enteropathy. Folia Endocrinol 1996;72:629-35.
  62. Oronsky B, Caroen S, Oronsky A, et al. Electrolyte disorders with platinum-based chemotherapy: mechanisms, manifestations and management. Cancer Chemother Pharmacol 2017;80:895-907.
  63. Elisaf M, Merkouropoulos M, Tsianos EV, et al. Pathogenetic mechanisms of hypomagnesemia in alcoholic patients. J Trace Elem Med Biol 1995;9:210-4.
  64. Brautbar N, Leibovici H, Massry SG. On the mechanism of hypophosphatemia during acute hyperventilation: Evidence for increased muscle glycolysis. Miner Electrolyte Metab 1983;9:45-50.
  65. Lee Hamm L, Hering-Smith KS, Nakhoul NL. Acid-Base and potassium homeostasis. Semin Nephrol 2013;33:257-64.
  66. Campos FP, Benvenuti LA. Eisenmenger syndrome. Autops Case Rep 2017;7:5-7.
  67. Wu Y. Systemic capillary leak syndrome presenting as apparent polycythemia vera: a critical diagnostic dilemma. J Hematol 2014;3:19-21.
  68. Engidaye G, Melku M, Enawgaw B. Diamond blackfan anemia: genetics, pathogenesis, diagnosis and treatment. EJIFCC 2019;30:67-81.
  69. Zonnenberg IA, Semmekrot BA. Neonatale polycytemie: voorbeelden uit de praktijk en overzicht van de literatuur. KIND 2005;73:215-9.
Wetenschap

Welke extreme laboratoriumresultaten kunnen patiënten nog overleven?

Lees online

Beoordeling van laboratoriummetingen vereist inzicht in de klinische plausibiliteit van de resultaten en of de waarden, zeker de meer extreme, überhaupt met het leven verenigbaar zijn. Om meer duidelijkheid te krijgen over welke waarden bij levende, niet-moribunde patiënten nog kunnen voorkomen zijn voor een tiental analytes (natrium, kalium, chloride, magnesium, fosfaat, totaal calcium, geïoniseerd calcium, pH en hemoglobine) de meest extreme resultaten uitgezocht over de jaren 2014-2018 in de database van een klinisch chemisch hematologisch laboratorium van een grote perifere opleidingskliniek. Om tot reële waarden te komen die nog met het leven verenigbaar bleken te zijn, moesten de gemeten waarden bevestigd zijn middels meerdere analyses, en moesten de patiënten na waarneming van het betreffende extreme resultaat nog tenminste 28 dagen leven. Per bepaling zijn de vijf hoogste en laagste resultaten opgezocht. Om enig inzicht te krijgen hoe betreffende extreme waarden kunnen ontstaan en met welke symptomen deze gepaard gaan is van deze patiënten de casuïstiek nagetrokken.

Literatuurlijst

  1. De Bruyn KMT, van der Horst M, van Ingen HE, et al. Richtlijn vrijgave van laboratoriumuitslagen. Ned Tijdschr Klin Chem Labgeneesk 2016;41:1-26.
  2. De Luca LA, Menani JV, Johnson AK. Neurobiology of Body Fluid Homeostasis: Transduction and Integration. Boca Raton (FL): CRC Press/Taylor & Francis; 2014.
  3. Wang YG, Zhou JC, Wu KS. High 28-day mortality in critically ill patients with sepsis and concomitant active cancer. J Int Med Res 2018;46:5030-9.
  4. Visiedocument Klinische Chemie en Laboratoriumgeneeskunde 2025. 2018.
  5. Hammerling JA. A review of medical errors in laboratory diagnostics and where we are today. Lab Med 2012;43:41-4.
  6. Ten Bos LM, Veenstra TC, Westerhof BD, et al. A case of extreme hypokalaemia. Neth J Med 2016;74:406-9.
  7. Scheuren A, Jürgensen JS, Krüger A, et al. Extreme hyponatremia of 87 mmol/l without neurologic complications in a severely hypovolemic patient. Am J Med 2000;109:679-81.
  8. Abelian A, Ghinescu CE. Premature baby with extreme hyponatraemia (95 mmol per litre): a case report. BMC Pediatr 2015;15:121.
  9. Yessayan L, Yee J, Frinak S, et al. Treatment of severe hyponatremia in patients with kidney failure: role of continuous venovenous hemofiltration with low-sodium replacement fluid. Am J Kidney Dis 2014;64:305-10.
  10. Borrego DRR, Imaz Roncero A, López-Herce CJ, et al. Severe hypernatremia: survival without neurologic sequelae. An Pediatr (Barc) 2003;58:376-80.
  11. Arambewela MH, Somasundaram NP, Garusinghe C. Extreme hypernatremia as a probable cause of fatal arrhythmia: a case report. J Med Case Rep 2016;10:272.
  12. Ofran Y, Lavi D, Opher D, et al. Fatal voluntary salt intake resulting in the highest ever documented sodium plasma level in adults (255 mmol L-1): a disorder linked to female gender and psychiatric disorders. J Intern Med 2004;256:525-8.
  13. Akinci B, Celik A, Saygili F, et al. A case of gitelman’s syndrome presenting with extreme hypokalaemia and paralysis. Exp Clin Endocrinol Diabetes 2009;117:69-71.
  14. Vogt W, Oesterle B. Extreme results in electrolyte determination. Wien Klin Wochenschr Suppl 1992;192:21-7.
  15. Kallen RJ, Rieger CHL, Cohen HS, et al. Near-fatal hyperkalemia due to ingestion of salt substitute by an infant. JAMA 1976;235:2125-6.
  16. Bosse GM, Platt MA, Anderson SD, et al. Acute oral potassium overdose: the role of hemodialysis. J Med Toxicol 2011;7:52-6.
  17. Horisberger T, Fischer JE, Waldvogel K. Long-term outcome of an infant resuscitated from iatrogenic potassium intoxication with a serum level of 17.7 mmol/l. Eur J Pediatr 2004;163:48-9.
  18. Niewiński G, Korta T, Debowska M, et al. Cardiac arrest in chronic metabolic alkalosis due to sodium bicarbonate abuse. Anestezjol Intens Ter 2008;40:173-7.
  19. Niederstadt C, Kurowski V, Djonlagic H. Severe metabolic alkalosis with a consciousness disorder. Dtsch Med Wochenschr 1996;121:978-82.
  20. Llitjos JF, Mongardon N, Crabol Y, et al. Extreme metabolic alkalosis: excessive alkali intake due to ulcerative disease. Nephrology (Carlton) 2013;18:844.
  21. Sotos JF, Cutler EA, Finkel MA, et al. Hypocalcemic coma following two pediatric phosphate enemas. Pediatrics 1977;60:305-7.
  22. Bergkamp FJ, van Berkel AM, van der Linden PW, et al. Unexpected prolonged extreme hypocalcaemia and an inadequate PTH response in a patient with metastatic breast carcinoma. Neth J Med 2003;61:371-5.
  23. Kabisch H, Niggemann B, Winkler K. Extreme hyperphosphatemia with hypocalcemia within the scope of cell lysis syndrome in a child with T-ALL. Onkologie 1989;12:64-8.
  24. Ranganath L, Jamal H, Jones L, et al. Value of assessing parathyroid hormone-like activity in a case of extreme hypercalcaemia. J Clin Pathol 1998;51:257-8.
  25. Marienhagen K, Due J, Hanssen TA, et al. Surviving extreme hypercalcaemia - a case report and review of the literature. J Intern Med 2005;258:86-9.
  26. Weng YM, Chen SY, Chen HC, et al. Hypermagnesemia in a constipated female. J Emerg Med 2013;44:e57-60.
  27. Tan AC, Janssens PM, Meijer JW, et al. Hypercalcemia due to adult T-cell lymphoma in a man from Surinam. Ned Tijdschr Geneeskd 2001;145:370-4.
  28. Semb S, Helgstrand F, Hjorne F, et al. Persistent severe hypomagnesemia caused by proton pump inhibitor resolved after laparoscopic fundoplication. World J Gastroenterol 2017;23:6907-10.
  29. Willows J, Al Badi M, Richardson C, et al. Case Report: investigation and molecular genetic diagnosis of familial hypomagnesaemia. F1000Res 2019;8:666.
  30. Gladziwa U, Schwarz R, Gitter AH, et al. Chronic hypokalaemia of adults: gitelman‘s syndrome is frequent but classical bartter‘s syndrome is rare. Nephrol Dial Transplant 1995;10:1607-13.
  31. Onishi S, Yoshino S. Cathartic-induced fatal hypermagnesemia in the elderly. Intern Med 2006;45:207-10.
  32. Kala J, Abudayyeh A. Magnesium: an overlooked electrolyte. J Emerg Med 2017;52:741-3.
  33. Van Dissel JT, Gerritsen HJ, Meinders AE. Severe hypophosphatemia in a patient with anorexia nervosa during oral feeding. Miner Electrolyte Metab 1992;18:365-9.
  34. Cubillos Celis MP, Nannig PM. Hypophosphatemia in preterm infants: a bimodal disorder. Rev Chil Pediatr 2018;89:10-7.
  35. Hsu HJ, Wu M-S. Extreme hyperphosphatemia and hypocalcemic coma associated with phosphate enema. Intern Med 2008;47:643-6.
  36. Opdahl H. Survival put to the acid test: extreme arterial blood acidosis (pH 6.33) after near drowning. Crit Care Med 1997;25:1431-6.
  37. Bey TA, Walter FG, Gibly RL, et al. Severe metabolic and survival after ethylene glycol poisoning in a patient with an arterial pH of 6.58. Vet Hum Toxicol 2002;44:167–8.
  38. Willcox N, Oakley P. Survival with an arterial pH of 6.57 following major trauma with exsanguinating haemorrhage associated with traumatic amputation. Resuscitation 2002;53:217-21.
  39. Collinet P, Subtil D, Puech F, et al. Successful treatment of extremely severe fetal anemia due to Kell alloimmunization. Obstet Gynecol 2002;100:1102-5.
  40. Ng KO, Chow LH, Wang CC, et al. Successful management of massive blood loss to extremely low hemoglobin in an elderly woman receiving spinal surgery. Acta Anaesthesiol Sin 2000;38:89-92.
  41. De Araújo Azi LMT, Lopes FM, Garcia LV. Postoperative management of severe acute anemia in a Jehovah’s Witness. Transfusion 2014;54:1153-7.
  42. Yip R. Significance of an abnormally low or high hemoglobin concentration during pregnancy: special consideration of iron nutrition. Am J Clin Nutr 2000;72:272S-279S.
  43. Beall CM, Brittenham GM, Macuaga F, et al. Variation in hemoglobin concentration among samples of high‐altitude natives in the Andes and the Himalayas. Am J Hum Biol 1990;2:639-51.
  44. Tewari SC, Jayaswal R, Kasthuri AS, et al. Excessive polycythaemia of high altitude. Pulmonary function studies including carbon monoxide diffusion capacity. J Assoc Physicians India 1991;39:453-5.
  45. Holley AD, Green S, Davoren P. Extreme hypernatraemia: a case report and brief review. Crit Care Resusc 2007;9:55-8.
  46. Das SK, Afroze F, Ahmed T, et al. Extreme hypernatremic dehydration due to potential sodium intoxication: consequences and management for an infant with diarrhea at an urban intensive care unit in Bangladesh: A case report. J Med Case Rep 2015;9:124.
  47. Marshall W, Lapsley M, Day A. Clinical Chemistry 8th edition. Elsevier; 2016.
  48. Hwang KS, Kim GH. Thiazide-induced hyponatremia. Electrolyte Blood Press 2010;8:51-7.
  49. Kalksma R, Leemhuis MP. Hyponatriëmie bij gebruik van thiazidediuretica: let op combinaties van geneesmiddelen die dit effect versterken. Ned Tijdschr Geneeskd 2002;146:1521-5.
  50. Fuzaylova I, Lam C, Talreja O, et al. Sacubitril/Valsartan (Entresto®)-induced hyponatremia. J Pharm Pract 2019;897190019828915.
  51. Raebel MA. Hyperkalemia associated with use of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers. Cardiovasc Ther 2012;30:e156-66.
  52. Kotchen TA. Antihypertensive therapy-associated hypokalemia and hyperkalemia: clinical implications. Hypertension 2012;59:906-7.
  53. Florentin M. Proton pump inhibitor-induced hypomagnesemia: a new challenge. World J Nephrol 2012;1:151-4.
  54. Huang CL, Kuo E. Mechanism of hypokalemia in magnesium deficiency. J Am Soc Nephrol 2007;18:2649-52.
  55. Neki NS. Hyperthyroid hypokalemic periodic paralysis. Pak J Med Sci 2016;32:1051-2.
  56. Durward A, Skellett S, Mayer A, et al. The value of the chloride:sodium ratio in differentiating the aetiology of metabolic acidosis. Intensive Care Med 2001;27:828-35.
  57. Funk GC, Zauner C, Bauer E, et al. Compensatory hypochloraemic alkalosis in diabetic ketoacidosis. Diabetologia 2003;46:871-3.
  58. Oberleithner H, Guggino W, Giebisch G. The effect of furosemide on luminal sodium, chloride and potassium transport in the early distal tubule of Amphiuma kidney. Effects of potassium adaptation. Pflugers Arch 1983;396:27-33.
  59. Enna SH, Bylund DB. Aldosterone antagonists. xPharm: The comprehensive pharmacology reference. Elsevier; 2008.
  60. Herrmann JB, Kirsten E, Krakauer JS. Hypercalcemic syndrome associated with androgenic and estrogenic therapy. J Clin Endocrinol Metab 1949;1:1-12.
  61. Shima F, Ishida Y, Yoshida R, et al. Severe hypocalcemia in a patient with protein-losing enteropathy. Folia Endocrinol 1996;72:629-35.
  62. Oronsky B, Caroen S, Oronsky A, et al. Electrolyte disorders with platinum-based chemotherapy: mechanisms, manifestations and management. Cancer Chemother Pharmacol 2017;80:895-907.
  63. Elisaf M, Merkouropoulos M, Tsianos EV, et al. Pathogenetic mechanisms of hypomagnesemia in alcoholic patients. J Trace Elem Med Biol 1995;9:210-4.
  64. Brautbar N, Leibovici H, Massry SG. On the mechanism of hypophosphatemia during acute hyperventilation: Evidence for increased muscle glycolysis. Miner Electrolyte Metab 1983;9:45-50.
  65. Lee Hamm L, Hering-Smith KS, Nakhoul NL. Acid-Base and potassium homeostasis. Semin Nephrol 2013;33:257-64.
  66. Campos FP, Benvenuti LA. Eisenmenger syndrome. Autops Case Rep 2017;7:5-7.
  67. Wu Y. Systemic capillary leak syndrome presenting as apparent polycythemia vera: a critical diagnostic dilemma. J Hematol 2014;3:19-21.
  68. Engidaye G, Melku M, Enawgaw B. Diamond blackfan anemia: genetics, pathogenesis, diagnosis and treatment. EJIFCC 2019;30:67-81.
  69. Zonnenberg IA, Semmekrot BA. Neonatale polycytemie: voorbeelden uit de praktijk en overzicht van de literatuur. KIND 2005;73:215-9.
Over dit artikel
Auteurs
Michiel Pot, Moniek Wouters, Henk van Leeuwen, Marcel van Borren, Pim Janssens
Over de auteurs
  • Dr. M.W Pot, AIOS klinische chemie, Klinisch Chemisch en Hematologisch Laboratorium, Rijnstate, Arnhem
  • M. Wouters, AIOS Longgeneeskunde, Longgeneeskunde, Rijnstate, Arnhem
  • Dr. H.J. van Leeuwen, internist-intensivist, Interne Geneeskunde, Rijnstate, Arnhem
  • Dr. M.M.G.J. van Borren, laboratoriumspecialist klinische chemie, Klinisch Chemisch Hematologisch Laboratorium, Rijnstate, Arnhem
  • Dr. P.M.W. Janssens, laboratoriumspecialist klinische chemie, Klinisch Chemisch Hematologisch Laboratorium, Rijnstate, Arnhem

Correspondentie: mpot@rijnstate.nl of pmw.janssens@kpnmail.nl

Printdatum
27 oktober 2020
E-pubdatum
30 oktober 2020
ISSN print
2589-4153
ISSN online
2589-6296
DOI
https://doi.org/10.24078/labgeneeskunde.2020.10.126047


Over dit artikel
Auteurs
Michiel Pot, Moniek Wouters, Henk van Leeuwen, Marcel van Borren, Pim Janssens
Over de auteurs
  • Dr. M.W Pot, AIOS klinische chemie, Klinisch Chemisch en Hematologisch Laboratorium, Rijnstate, Arnhem
  • M. Wouters, AIOS Longgeneeskunde, Longgeneeskunde, Rijnstate, Arnhem
  • Dr. H.J. van Leeuwen, internist-intensivist, Interne Geneeskunde, Rijnstate, Arnhem
  • Dr. M.M.G.J. van Borren, laboratoriumspecialist klinische chemie, Klinisch Chemisch Hematologisch Laboratorium, Rijnstate, Arnhem
  • Dr. P.M.W. Janssens, laboratoriumspecialist klinische chemie, Klinisch Chemisch Hematologisch Laboratorium, Rijnstate, Arnhem

Correspondentie: mpot@rijnstate.nl of pmw.janssens@kpnmail.nl

Printdatum
27 oktober 2020
E-pubdatum
30 oktober 2020
ISSN print
2589-4153
ISSN online
2589-6296
DOI
https://doi.org/10.24078/labgeneeskunde.2020.10.126047