Kettritz R, Luft F C
Nephrologie und Internistische Intensivmedizin, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Deutschland,
Internist (Berl). 2015 Jul;56(7):745-52. doi: 10.1007/s00108-015-3671-6.
The maintenance of water and electrolyte homeostasis is of enormous importance for the functioning of cells and tissues. A number of therapeutic procedures intentionally or unintentionally influence important regulatory mechanisms of these interdependent balanced systems. Excessive salt intake doesn't only expand the extracellular volume; it can also cause a considerable increase in tonicity. Owing to its insulin-dependent duality of action, glucose can represent an effective or an ineffective osmolyte. This fact has to be considered in patients with diabetic ketoacidosis. Diuretics reduce the volume expansion via renal excretion of sodium (and water); however, in addition to hypokalemia, diuretics can also cause severe alkalosis. Nowadays, hemodialysis is a routine procedure-but even routine procedures can deliver undesirable surprises. Can dialysis cause an increase in calcium levels, or does the procedure remove therapeutically administered radioactive iodine? The current article presents a series of cases we have come across in recent years. These case reports illustrate common, but also rare iatrogenic situations. The discussion of these cases is aimed at raising awareness of the issues involved in a pathophysiological approach to clinical problems.
水和电解质平衡的维持对于细胞和组织的功能极为重要。许多治疗程序有意或无意地影响这些相互依存的平衡系统的重要调节机制。过量摄入盐不仅会使细胞外液量增加，还会导致张力显著升高。由于葡萄糖具有胰岛素依赖的双重作用，它既可以是有效的渗透溶质，也可以是无效的渗透溶质。这一事实在糖尿病酮症酸中毒患者中必须予以考虑。利尿剂通过肾脏排泄钠（和水）来减少血容量扩张；然而，除了低钾血症外，利尿剂还可能导致严重的碱中毒。如今，血液透析是一种常规程序——但即使是常规程序也可能带来意想不到的意外情况。透析会导致钙水平升高吗？或者该程序会清除治疗中使用的放射性碘吗？本文介绍了我们近年来遇到的一系列病例。这些病例报告阐述了常见的以及罕见的医源性情况。对这些病例的讨论旨在提高人们对临床问题病理生理学方法中所涉及问题的认识。
