university of groningen acute metabolic changes in ... file111 effect insulin on renal potassium...

University of Groningen

Acute metabolic changes in critical care and cardiac careHoekstra, Miriam

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Citation for published version (APA):Hoekstra, M. (2016). Acute metabolic changes in critical care and cardiac care: Role of potassium, glucoseand lactate. [Groningen]: University of Groningen.

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Haiashortril—ny—sartd—.nitllomh—aFusaionror—usoioutdd,—odd—.tioarilT—Rpa—snda—ny—orlmdoripast.,

:

–na-list—Av—Yap—Jv—qmca—Jtrlor-—5v—Vnfadxtrf—Av—Atipo/l—Av—9iafahtr—)5—GncfaslADgK—1tr—cas—–nsli—C)v—%oaitlup—B<v—Zo/dlist—Uv—jo/liar—A%g

Modified from Critical Care Medicine 2012; 40(3): 762–765.

20151129_quarkx manuscript.qxp_proefschrift M Hoekstra 29/11/15 21:38 Page 109

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Abstract

ObjectivesCrlmdor—tchorolistionr—dn0asl—.dtlht—.nitllomh—unruaristionr—w,—tmfhariorf—oristuaddmdts—m.it-a—ny.nitllomhg—Rpa—ayyaui—ny—orlmdor—tchorolistionr—nr—sartd—.nitllomh—aFusaionr—ol—mrudatsg—9nha—limcoallmffali—ipti—orlmdor—ptl—tr—trio-tdomsaiou—ayyaui—tdipnmfp—.dtlht—.nitllomh—da1adl—0asa—.nnsd,—unrisnddacg9orua— ipa— orisncmuionr—ny—fd,uahou—unrisnd— or— ipa— oriarlo1a—utsa—mroiv— orlmdor—mla—ptl— orusatlacg—%aaFthorac—ipa—sadtionr—wai0aar—tchoroliasac—orlmdor—trc—sartd—.nitllomh—aFusaionr—or—usoioutdd,—odd—.tioarilmrcas—unh.miasMtlloliac—fdmunla—trc—.nitllomh—safmdtionrg

Design7snl.auio1a—nwlas1tionrtd—limc,g

SettingR0ad1aMwac—lmsfoutd—oriarlo1a—utsa—mroi—ny—t—mro1asloi,—iatuporf—pnl.oitdg

Patients)nrlaumio1a—oriarlo1a—utsa—mroi—.tioarilg

Interventions7nitllomh—trc—fdmunla—da1adl—0asa—safmdtiac—w,—t—unh.miasMtlloliac—cauolonr—lm..nsi—l,liahg—Enip.nitllomh—trc—orlmdor—0asa—unriormnmld,—tchoroliasac—w,—l,sorfa—.mh.g

Measurements and Main ResultsGartd—.nitllomh—aFusaionr—0tl—hatlmsac—ctod,—or—ipa— kMps—msora—unddauionrlg—Rpa— kMps—msorts,—lth.dalny—.tioaril—0oip—-ocra,—ytodmsa—ns—nr—sartd—sa.dtuahari—ipast.,—0asa—aFudmcacg—Amdio1tsotia—trtd,lol—0oip.nitllomh—aFusaionr—tl—ipa—ca.arcari—1tsotwda—0tl—.asynshacg—Cr—b6:—unrlaumio1a—.tioarilv—bvkPS— kMpsmsorts,—lth.dalv—0asa—trtd,lacg—Aatr—±—9H—.dtlht—.nitllomh—0tl—kg ±g4—hhndWJv—0oip—68±kS—hhndWcny—.nitllomh—tchoroliasac—trc—t—hatr—orlmdor—cnla—ny—P4±4:—NWct,g—Gartd—.nitllomh—aFusaionr—0tlb S±Pb—hhndWct,g—5yias—hmdio1tsotia—trtd,lol—unssauiorf—yns—sada1tri—1tsotwdal—3orudmcorf—comsaioulv—.–v.nitllomh—da1adl—trc—sartd—lncomh—aFusaionr(v—orlmdor—tchorolistionr—0tl—orca.arcarid,—trc—.nloio1ad,tllnuotiac—0oip—sartd—.nitllomh—aFusaionrg—qipas—lofroyoutri—1tsotwdal—0asa—.nitllomh—da1adlv—.nitllomhtchorolistionrv—sartd—lncomh—trc—updnsoca—aFusaionrv—usatiorora—udatstruav—comsaiou—ipast.,v—.–v—-rn0rcotwaial—trc—oriarlo1a—utsa—mroi—tchollonr—ct,—3G =gP K—7OgIIb(g

ConclusionCrlmdor—tchorolistionr— ol—tllnuotiac—0oip—tr— orusatla— or— ipa— sartd—.nitllomh—aFusaionr— or—usoioutdd,— odd.tioarilg


111

Effect Insulin on Renal Potassium Excretion

8

Introduction

9orua—ipa—orisncmuionr—ny—fd,uahou—unrisnd—or—ipa—usoioutdd,—odd—.tioariv—ipa—mla—ny—orlmdor—or—ipa—oriarlo1a—utsamroi—3C)N(—ptl—orusatlac—csthtioutdd,—bg—Ealocal—ipa—m.it-a—ny—fdmunlav—orlmdor—.snhnial—la1astd—nipas.snuallal—do-a—ipa—oristuaddmdts—m.it-a—ny—.nitllomh— v—trc—ipasaynsa—orlmdor—ol—safmdtsd,—t..doac—in—causatlalasmh—.nitllomh—da1adl—0par—p,.as-tdahot—ol—.salari—4g—%paipas—ipa—.nitllomhMdn0asorf—ayyaui—ny—orlmdorol—tdln—tyyauiac—w,—orlmdorMorcmuac—uptrfal—or—sartd—.nitllomh—aFusaionr—3G7z(—ol—mrudatsg—DdmunlaWorlmdorudth.—limcoal—or—pmhtr—1ndmriaasl—pt1a—orcoutiac—ipti—orlmdor—ptl—tr—trio-tdomsaiou—ayyaui—kL6g—–n0a1asvipala—limcoal—tsa—pth.asac—w,—orlmyyouoari—unrisnd—ny—.dtlht—.nitllomhv—wautmla—ipa—cohorolpac—.dtlht.nitllomh—tyias—orlmdor—tchorolistionr—unmdc—tdln—aF.dtor—ipa—causatlac—G7z—:v—8g—Rn—aFthora—ipa—.nllowdaorydmarua—ny—orlmdor—nr—G7zv—oi—0nmdc—wa—.sayastwda—in—pt1a—unrcoionrl—mrcas—0poup—wnip—.nitllomh—trcfdmunla— da1adl— tsa— iofpid,— safmdtiacg— Cr— nms— C)Nv—0a—mla— t— unh.miasMlm..nsiac— l,liah— ipti— lisouid,safmdtial—wnip—.nitllomh—trc—fdmunla—da1adl—0oip—.asoncou—tc/mliharil—ny—unriormnml—.nitllomh—trcorlmdor—orymlonr—bIv—bbg—%a—limcoac—ipa—sadtionr—wai0aar—orlmdor—tchorolistionr—trc—sartd—.nitllomh—aFusaionror—t—unpnsi—ny—C)N—.tioarilg

Methods

Study populationRpol—.snl.auio1a—nwlas1tionrtd—limc,—0tl—.asynshac—nr—t—b Mwac—lmsfoutd—C)N—ny—t—mro1asloi,—pnl.oitdg%oip—t..sn1td—ny—ipa—orlioimionrtd—sa1oa0—wntsc—0a—unddauiac—trc—lmwla marid,—trtd,lac—ipa— kMps—msorts,lth.dal—ny—tdd—unrlaumio1a—.tioaril—0pn—0asa—tchoiiac—cmsorf—t—b4Mhnrip—.asonc—3Btrmts,— IIS—inUawsmts,— II6(g—Rpa—orlioimionrtd—sa1oa0—wntsc—t..sn1ac—ipa—limc,—3AzR)— IISW :(g—Eautmla—wnip—ipaunddauionr—ny— kMps—msorts,—lth.dal—trc—unh.miasoxac—.nitllomh—trc—fdmunla—unrisnd—0asa—.tsi—ny—snmioraudoroutd—utsav—ipa—sa mosahari—yns—orynshac—unrlari—0tl—0to1ac—w,—nms—hacoutd—aipoutd—unhhoiiaag—Rpamsorts,—lth.dal—nwitorac—nr—ct,l—0par—usatiorora—udatstrua—0tl—rni—t1todtwda—ns—rn—orlmdor—cnlorf—0tlsaunscac—ns—0par—ipa—.tioari—0tl—nr—sartd—sa.dtuahari—ipast.,—ns—ptc—t—hatlmsac—usatiorora—udatstruaO P—hJWhor—0asa—rni—orudmcac—or—ipa—trtd,lolg

Potassium and glucose regulationDdmunla—trc—.nitllomh—da1adl—or—tdd—.tioaril—0asa—safmdtiac—w,—ipa—.sa1onmld,—calusowac—unh.miasoxaccauolonr—lm..nsi—l,liah—utddac—DGC7MCC—3Ddmunla—trc—.nitllomh—Gafmdtionr—or—Criarlo1a—utsa—7tioaril(—bIvbbg—Ci—ol—t—rmslaMuariasac—l,liah—ipti—.sn1ocal—t—saunhharctionr—twnmi—wnip—ipa—thnmri—ny—.nitllomhtrc—orlmdor—in—wa—3unriormnmld,(—tchoroliasac—trc—ipa—lth.dorf—orias1tdg—Rpol—saunhharctionr—ol—htord,wtlac—nr—ipa—dtiali—tsiasotd—.nitllomh—trc—fdmunla—da1adl—tl—0add—tl—ipa—isarc—or—.nitllomh—trc—fdmunlada1adlg—%a—calofrac—ipa—.nitllomh—unrisnd—tdfnsoiph—in—toh—yns—t—.nitllomh—da1ad—wai0aar—4g:—trc—kgkhhndWJg—Rpa—wdnnc—fdmunla—itsfai—strfa—0tl—lai—in—kgIL6gP—hhndWJg—5dd—tchoiiac—.tioaril—0asa—htrtfacw,—DGC7MCCg—zFua.i—yns—ipa—unriormnmld,—tchoroliasac—.nitllomh—safmdtiac—w,—DGC7MCCv—ipa—nrd,—nipas.nitllomh—tchoroliasac—0tl—ipsnmfp—ariastd—3.sayassac(—ns—.tsariastd—yaacorfg—7nitllomh—trc—fdmunlada1adl—0asa—hatlmsac—or—tsiasotd—wdnnc—lth.dal—mlorf—t—.noriMnyMutsa—wdnnc—ftl—trtd,las—35EJ—stconhaias6IIW:II—lasoalv—)n.arptfarv—Harhts-(—b g


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Data collection and statistical analysisqy—tdd—.tioarilv—0a—saunscac—ipa—wtladora—cahnfst.poulv—satlnr—yns—tchollonrv—trc—la1asoi,—ny—oddrall—tlaliohtiac—w,—ipa—5umia—7p,londnf,—trc—)psnrou—–atdip—z1tdmtionr—CC—lunsa—b4g—Rpa— kMps—msora—lth.dal3litsiorf—in—unddaui—ti—hocrofpi(—ny—tdd—orudmcac—.tioaril—0asa—snmiorad,—unddauiac—trc—trtd,lac—0oipor— kpsl—yns—1ndmha—tl—0add—tl—.nitllomhv—lncomhv—updnsocav—trc—usatiorora—unruaristionrlg—Ednnc—lncomh—trcusatiorora—1tdmal— 3hatlmsac—ctod,(—0asa— saisoa1ac— ysnh— ipa—pnl.oitd—udoroutd— orynshtionr—l,liahg—Rpausatiorora—udatstrua—0tl—utdumdtiac—ctod,—mlorf—ipa—wdnnc—usatiorora—da1ad—trc—ipa—unssal.nrcorf—msorts,usatiorora— aFusaionrg— Rpa— ctod,— orist1arnmld,— tchoroliasac— thnmril— ny— .nitllomh— trc— orlmdor— 0asacaiashorac—trc—tminhtioutdd,—saunscac—w,—ipa—DGC7MCC—l,liahg—Rpa—mla—ny—comsaiou—tfarilv—p,csnunsiolnravitusndohmlv—utiaupndthoralv—[wait]Mwdnu-aslv—trc—cofnFor—0tl—saisnl.auio1ad,—unddauiac—trc—0tl—cayoractl—ipaos—mla—cmsorf—ipa—ct,—ny—unddauionr—ns—tyias—STII—7A—ipa—.sa1onml—ct,g

Uns—tdd—.tioaril—0a—utdumdtiac—ipa—iohaMt1astfac—ctod,—wdnnc—.nitllomh—trc—fdmunla—da1adl—bkg—Uns0tsclia.0ola—hmdio1tsotia—dorats—safsallonr—trtd,lol—0tl—.asynshac—0oip—G7z—tl—ipa—ca.arcari—1tsotwdag—Rpala1tsotwdal—0asa—orlmdor—trc—.nitllomh—tchorolistionrv—wdnnc—.nitllomhv—wdnnc—fdmunlav—sartd—lncomh—trcupdnsoca—aFusaionrv—.–v—ipa—mla—ny—comsaioulv—usatiorora—udatstruav—trc—ipa—C)N—tchollonr—ct,g—5dd—1tsotwdal

Table 1 7tioari—uptstuiasolioulgjng b6:5fav—,slv—hatr—±—9H SI±bSAtda—laF bI:—3Sb(Gatlnr—ny—tchollonr—5wcnhortd—lmsfas,— S8—348(–a.tinwodots,—lmsfas, 6—3bP(Vtlumdts—lmsfas,— b:—3bI(Rstmht S—3bP(Aacoutd— 6—3k(jamsndnfou bb—3S(Aoluaddtranml I—3bb(

–olins,—ny—cotwaial 4 —3b:(Crlmdor—ca.arcari—cotwaial b6—3bI(

575)–z—CC*—lunsa bS—3bbLb8(Jarfip—ny—lit,—ti—ipa—oriarlo1a—utsa—mroiv—ct,l :—3PLb6(Criarlo1a—utsa—mroi—hnsitdoi, bS—38(jmhwasl—tsa—aF.sallac—tl—hacotrl—3orias mtsioda—strfa(—ns—rmhwasl—3;(—mrdall—nipas0ola—l.auoyoalg575)–z—CCv—5umia—7p,londnf,—trc—)psnrou—–atdip—z1tdmtionr—CCK—9H—litrctsc—ca1otionrg

Table 2 5rtd,lol—ny—bkPS— kMps—msorts,—lth.dal—trc—ctit—ny—ipa—unddauionr—ct,lgNsora7nitllomhv—hhndW k—ps b b—3::LbPk(9ncomhv—hhndW k—ps bPb—3: L Pk()pdnsocav—hhndW k—ps b8k—3bb4L4bI()satiororav—hhndW k—ps 8gb—3SgbLb g4(

Ednnc7nitllomhv—hhndWJt kg —3kgILkg4(Ddmunlav—hhndWJt Sg:—3SgPL6gb(w)satiororav— hndWJ SP—3kPL86(.– 6gk4—36gkIL6gkS(

CrymlonrlCrlmdorv—NW k—ps kS—3 kL6k(7nitllomhv—hhndW k—ps 6 —3k:LbIb(

tRohaMt1astfacgwz mo1tdari—in—b —3bb6Lb :(—hfWcJg—


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ipti—ptc—t—mro1tsotia—sadtionr—0oip—G7z—0oip—t—7OgbI—0asa—a1tdmtiac—yns—hmdio1tsotia—trtd,lolg—Rpa—lia.0olahncad—litsiac—0oip—ipa—hnli—.p,londnfoutdd,—hnli—a1ocari—caiashortril—ny—.nitllomh—aFusaionrv—ipti—olv.nitllomh—da1adv—.nitllomh—tchorolistionrv—trc—usatiorora—udatstruag—Uns—ctit—.snuallorf—trc—litiolioutdtrtd,lolv—ipa—9itiolioutd—7tu-tfa—yns—ipa—9nuotd—9uoarual—39799—Crugv—)poutfnv—CJ(—1aslonr—bPgI—0tl—mlacg5—i0nMlocac—7OgIP—0tl—unrlocasac—lofroyoutrig

Results

Hmsorf— ipa— limc,— .asoncv— 4b6I— kMps— msorts,— lth.dal—0asa— unddauiacg— Cr— bIb4— utlalv— rn— usatiororaudatstrua—0tl—t1todtwda—trc—or—PkP—utlal—ipa—.tioari—ptc—t—utdumdtiac—usatiorora—udatstrua—O P—hJWhorns—0tl—nr—sartd—sa.dtuahari—ipast.,—3b44—utlal(g—Rpa—msorts,—lth.dal—ny—ipala—.tioaril—0asa—aFudmcacg5rnipas—bPS—utlal—0asa—aFudmcac—wautmla—rn—saunscac—orlmdor—cnlorf—0tl—t1todtwdag—Rpasaynsav—yortdtrtd,lol—0tl—.asynshac—nr—bkPS— kMps—msorts,—lth.dal—ny—b6:—.tioarilg—Etladora—uptstuiasolioul—ny—ipala.tioaril—tsa—cahnrlistiac—or—Rtwda—bg—Rpa—hatr—±—9H—tfa—0tl—SI±bS—,sl—trc—bI:—.tioaril—3Sb;(—0asahtdag—Rpa—ht/nsoi,—ny—.tioaril—0asa—tchoiiac—tyias—t—lmsfoutd—.snuacmsag—5—polins,—ny—cotwaial—3wnip—orlmdortrc— rnrorlmdorMca.arcari(— 0tl— .salari— or— b:;g— Eo1tsotia— unssadtionr— trtd,lol— wai0aar— hatlmsacusatiorora—udatstrua—trc—.nitllomh—aFusaionr—lpn0ac—t—fstcmtd—sadtionr—0oip—rn—twsm.i—ipsalpndc—wadn00poup—G7z—litsiac—in—ytdd—nyyv—a1ar—0par—lth.dal—0oip—t—usatiorora—udatstrua—O P—hJWhor—0asa—orudmcac3G =g4Iv—7OgIIb(g

Nrcas—unh.miasMtlloliac—unrisndv—hacotr—wdnnc—.nitllomh—nr—ipa—unddauionr—ct,l—ny—ipa—bkPS— kMpsmsorts,—lth.dal—0tl—kg —3kgILkg4(—hhndWJ—trc—hacotr—fdmunla—0tl—Sg:—3SgPL6gb(—hhndWJ—3b —[bb6Lb :]hfWcJ(—3Rtwda— (g—Rpa—hacotr—thnmri—ny—tchoroliasac—.nitllomh—updnsoca—0tl—6 —3k:LbIb(—hhndWct,—34gIhhndWps(g—Hmsorf—ipa—unddauionr—ct,lv—tdd—.tioaril—0asa—nr—orlmdor—ipast.,—0oip—t—hacotr—orlmdor—orymlonrstia—ny—kS—3 kL6k(—NWct,—3a mo1tdari—in—bg8—NWps(g—Rpa—hacotr—G7z—0tl—b b—3::LbPk(—hhndWct,—trc—lncomhaFusaionr—0tl—bPb—3: L Pk(—hhndWct,g—7tioaril—0oip—-rn0r—cotwaial—ptc—t—lofroyoutrid,—dn0as—G7z—iptr.tioaril—0oipnmi—cotwaialT—bI8—3:kLbkb(—unh.tsac—0oip—b 4—3:8LbP:(—hhndWct,—37OgIIb(g—Rpa,—tdln—ptct—lofroyoutrid,—pofpas—orlmdor—sa mosahari—ny— g:—3bg:LkgI(—unh.tsac—in—bg:—3g8L g6(—NWps—37OgIIb(g—Enip.nitllomh—trc—fdmunla—0asa—lofroyoutrid,—pofpas—or—cotwaioul—0oip—.nitllomh—kg —3kgILkg4(—1lg—kgb—3kgILkg4(—hhndWJ—trc—fdmunla—Sg8—3SgSL6gk(—1lg—Sg6—3SgkL6gI(—gP—hhndWJ—3wnip—7OgIIb(g—%oip—tdd—.tioaril—0oip

Table 3 Amdio1tsotia—trtd,lol—ny—msorts,—.nitllomh—aFusaionrgVariables B (95% Confidence Interval) pEdnnc—.nitllomh b6gI—36gkL Sg6( gIIbEdnnc—fdmunla Mbg6—3MPgbLbg6( j9Crlmdor—orymlonr—stiav—NWps Sg4—3PgIL6g6( OgIIb7nitllomh—updnsoca—orymlonrv—hhndWps bbgI—38gPLb gP( OgIIbNsorts,—lncomh—aFusaionrv—hhndWct, Mgbk3Mgb:—in—MgbI( OgIIbNsorts,—updnsoca—aFusaionrv—hhndWct, g I—3gbSLg k( OgIIb)satiorora—udatstrua gb —3gI:LgbS( OgIIb.– b44—3::Lb6:( OgIIbHomsaiou—ipast.,— b gS—3:gILb6g4( OgIIb–,csnunsiolnra—ipast., MPg —3Mb4gPL4gb( j9Hotwaial M6gP—3Mb g6—in—M g4( gIIPCriarlo1a—utsa—mroi—tchollonr—ct, gbk—3gIPLg k( gII4j9v—rnr—lofroyoutrig


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Figure 1 N..as—.tradT—hacotr—3orias mtsioda—strfa(—wdnnc—.nitllomh—da1adl—3ipor— dora(—trc—.nitllomhorymlonr—3ipou-—dora(K—Jn0as—.tradT—msorts,—.nitllomh—aFusaionr—3ipor—dora(—trc—orlmdor—orymlonr—3ipou-—dora(cmsorf—ipa—yosli—6—ct,l—tyias—oriarlo1a—utsa—mroi—3C)N(—tchollonrgRpa—rmhwas—ny—or1alioftiac— kMps—msora—lth.dal—0asa—8k—nr—ct,—b—trc—: v—::v—6bv—Pbv—k6v—trc—kS—nr—ipa—lmwla marict,lg—7nitllomh—da1adl—0asa—htoritorac—ti—kg —hhndWJ—0oip—t—hncastia—sola— or—.nitllomh—trc— orlmdor— orymlonr—3tlunrisnddac—w,—ipa—DGC7MCC—.snfsth(g—Rpa—orusatla—or—orlmdor—sa mosahari—trc—sartd—.nitllomh—aFusaionr—unmdc—wa—aF.dtoracw,—ipa—orisncmuionr—ny—ariastd—ns—.tsariastd—rmisoionrg


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8

sartd—ytodmsa—ns—sartd—sa.dtuahari—ipast.,—tdsatc,—aFudmcacv—ipa—hacotr—usatiorora—udatstrua—3utdumdtiacctod,(—0tl—8S—3SbLbkI(—hJWhorg—qy—ipa—bkPS— kMps—msorts,—lth.dalv—PP4—34:;(—0asa—it-ar—mrcas—ipa—mlany—comsaiou—tfaril—trc—:8—3S;(—mrcas—ipa—mla—ny—p,csnunsiolnrag—qy—ipa—nipas—.niariotdd,—sada1tri—csmflipti—hofpi—tyyaui—.nitllomh—aFusaionrv—itusndohml—0tl—mlac—or—P;v—cnwmithora—or—k;v—cn.thora—or—I;vwaitMwdnu-orf—tfaril—or—:;v—trc—cofnFor—or— ;—ny—ipa—.tioarilg

Uofmsa—b—lpn0l—ipa—ioha—unmsla—ny—hacotr—.nitllomhv—.nitllomh—orymlonrv—orlmdor—orymlonrv—trc—G7z—cmsorfipa—yosli—P—ct,l—tyias—C)N—tchollonrg—Enip—nr—mro1tsotia—trc—hmdio1tsotia—trtd,lolv—orlmdor—tchorolistionr0tl—tr—orca.arcari—.nloio1a—.sacouins—ny—G7z—37OgIIb(g—Rpa—unssadtionr—unayyouoari—ny—ipol—hncad—0tl—g63G =gP v—7OgIIbK—Rtwda—4(g—Uns—a1as,—hhnd—orusatla—or—pnmsd,—.nitllomh—orymlonrv—G7z—orusatlac—0oip—b6gIhhndWct,g—Uns—a1as,—mroi—orusatla—or—orlmdor—tchorolistionr—.as—pnmsv—G7z—orusatlac—0oip—Sg4—hhndWct,g

Discussion

Cr— unristli— in— .sa1onml— limcoal— or— pmhtrlv— or— nms— limc,v— ipa— thnmri— ny— orlmdor— tchoroliasac— 0tlorca.arcarid,—tllnuotiac—0oip—orusatlac—sartd—aFusaionr—ny—.nitllomh—or—usoioutdd,—odd—.tioarilg—Rpsnmfp—trt..sntup—in—.nitllomh—safmdtionr—ipti—ol—lnha0pti—trtdnfnml—in—udth.orfv—0a—0asa—twda—in—htoritorlitwda—wdnnc—.nitllomh—1tdmal—3Uofg—b(—ln—0a—unmdc—trtd,la—ipa—orydmarua—ny—orlmdor—nr—G7z—0oipnmi—ipawdnnc—.nitllomhMdn0asorf—loca—ayyaui—ipti—unrynmrcac—nipas—limcoalg

qrd,—t—ya0—limcoal—pt1a—tccsallac—ipa—sadtionr—wai0aar—orlmdor—trc—G7zg—Cr—b86Pv—t—limc,—w,—HaUsnrxnai—td—k ynmrc—ipti—or—1ndmriaasl—t—fdmunlaWorlmdor—orymlonr—utmlac—causatlac—msorts,—lncomh—trc—.nitllomhaFusaionrg—–n0a1asv—ipa—causatlac—G7z—0tl—unm.dac—0oip—t—lofroyoutri—causatla—or—.dtlht—.nitllomhgJtias—limcoal—or—patdip,—lmw/auil—Pv—.tioaril—0oip—cotwaial—Sv—trc—.tioaril—0oip—allariotd—p,.asiarlonr—6tdln—ynmrc—causatlac—msorts,—.nitllomh—3trc—lncomh(—aFusaionr—unm.dac—0oip—t—csn.—or—lasmh—.nitllomhgRpala—limcoal—coc—rni—toh—in—litwodoxa—ipa—.dtlht—.nitllomh—mrcas—orlmdor—tchorolistionrg—Rpasaynsav—tlimc,—w,—Usoacwasf—ai—td—limcoac—oy—ipa—sartd—.nitllomh—trc—lncomhMsaitororf—ayyaui—ny—orlmdor—unmdc—wahacotiac—w,—t—litia—ny—p,.n-tdahotg—Cr—i0n—limcoal—or—patdip,—1ndmriaaslv—ipa,—cahnrlistiac—ipti—0parorlmdor— trc— .nitllomh— updnsoca—0asa— tchoroliasac— infaipasv— rn— uptrfal— or— .nitllomh— trc— lncomhudatstrua—nuumssac—:v—8 5—limc,—or—stil—or—0poup—t—amfd,uahou—p,.asorlmdorahou—udth.—0tl—t..doac—bPlpn0ac—ipti—0oipnmi—tchorolistionr—ny—.nitllomhv—ipa—lasmh—.nitllomh—csn..ac—0oip—rn—uptrfa—or—G7zg%par— orlmdor— 0tl— tchoroliasac— infaipas— 0oip— .nitllomh— in—htoritor— t— unrlitri— lasmh— .nitllomhunruaristionrv—G7z—orusatlac—ti—t—ytuins— gk—bSg

Crlmdor—arptrual—uaddmdts—.nitllomh—m.it-a—w,—liohmdtiorf—ipa—jtM<M5R7tla—.mh.— g—Rpa—sartd—imwmdtsloia—ny—orlmdor—tuionr—nr—lncomh—trc—.nitllomh—aFusaionr—ol—unrisn1aslotdg—9a1astd—l.auoyou—sartd—orlmdorsaua.insl—pt1a—waar—cahnrlistiacv—htord,—tdnrf—–arda’l—dnn.—trc—ipa—colitd—unr1ndmiac—imwmda—bSg—Anliny—ipa—yodiasac—.nitllomh—ol—satwlnswac—w,—ipa—.snFohtd—imwmda—trc—ipa—tluarcorf—dnn.—ny—–ardag—Cr—ipacolitd—imwmda—trc—ipa—unsioutd—unddauiorf—imwmdav—lausaionr—ns—tccoionrtd—.nitllomh—salns.ionr—nuumslvca.arcorf—nr—ipa—raacl—ny—ipa—wnc,—b6g—<rn0r—ytuinsl—ipti—safmdtia—ipa—sartd—.nitllomh—aFusaionr—tsaipa—.dtlht—.nitllomh—unruaristionrv—tdcnliasnra—da1adlv—ipa—imwmdts—ydn0—stiav—trc—tuocMwtla—uptrfalb:L Ig—5l—columllacv—ipa—doiastimsa—ol—thwofmnml—nr—ipa—snda—ny—orlmdor—or—.nitllomh—aFusaionrg—qms—ctitv


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III

pn0a1asv—lisnrfd,—lmffali—ipti—orlmdor—ptl—t—cosaui—orydmarua—nr—sartd—imwmdts—.nitllomh—aFusaionrv—wautmlaipa—ayyaui—utrrni—wa—aF.dtorac—w,—uptrfal—or—.dtlht—.nitllomh—trc—ol—orca.arcari—ysnh—nipas—-rn0rytuinsl—ipti—orydmarua—.nitllomh—aFusaionr—lmup—tl—-ocra,—ymruionrv—lncomh—aFusaionrv—trc—comsaiou—ipast.,gRpa—.nloio1a—ayyaui—ny— orlmdor—nr—sartd—.nitllomh—aFusaionr—utr—wa—udoroutdd,—sada1tri— or—.tioaril—0oipp,.as-tdahotg—Eautmla—orlmdor—t..atsl—in—tlloli—or—-tdomsalolv—yats—ny—orcmuorf—sartd—.nitllomh—saiarionrw,—orlmdor—tchorolistionr—ptl—rn—ynmrctionr—or—nms—ctitg—5dlnv—hnsa—caitodac—iah.nstd—trtd,lolv—ogagv—nrioha—lutdal—ny—pnmslv—ny—ipa—ayyaui—ny—fdmunlaWorlmdor—unrisnd—nr—G7z—ol—t—dnfoutd—raFi—lia.—or—udoroutdsalatsupg

5—dohoitionr—ny—ipol—nwlas1tionrtd—limc,—ol—ipti—.tioaril—yns—0pnh—ipa—ayyaui—ny—orlmdor—0nmdc—wa—.tsioumdtsd,sada1triv—ogagv—.tioaril—0oip—p,.as-tdahotv—0asa—rni—.salari—or—nms—unpnsig—5dln—ipa—thnmri—ny—.nitllomhtchoroliasac—ipsnmfp—ariastd—ns—.tsariastd— yaacorf—0tl—rni— orudmcac—or—ipa—trtd,lolg—Rpala—tsa—tdlnlmw/auil—yns—ymimsa—salatsupg

Conclusion

Crlmdor—0tl—sadtiac—in—orusatlac—sartd—.nitllomh—aFusaionr—or—usoioutdd,—odd—.tioaril—mrcas—unrcoionrl—0oipunh.miasMtlloliac—.nitllomh—trc—fdmunla—unrisndg


117


8

References

bg Vtr—car—Easfpa—Dv—%nmiasl—7v—%aa-asl—Uv—Vas0tali—)v—Esm,roru-F—Uv—9upaix—Av—Vdtlladtasl—HvUascortrca—7v—Jtm0asl—7v—Enmoddnr—GT—Criarlo1a—orlmdor—ipast.,—or—ipa—usoioutdd,—odd—.tioarilg—j—zrfdB—Aac— IIbK—4kPTb4P8Lb4S6g

g )dtmlar—Rv—z1asil—AzT—Gafmdtionr—ny—ipa—jt+W<+—.mh.—or—l-adaitd—hmludag—<ocra,—Cri—b8:8K—4PTbLb4g

4g –td.asor—AJv—<thad—<9T—7nitllomhg—Jtruai—b88:K—4P Tb4PLbkIgkg HaUsnrxn—G5v—)nn-—)Gv—5rcsal—5v—Utdnnrt—DGv—Ht1ol—7BT—Rpa—ayyaui—ny—orlmdor—nr—sartd—ptrcdorf

ny—lncomhv—.nitllomhv—utduomh—trc—.pnl.ptia—or—htrg—B—)dor—Cr1ali—b86PK—PPT:kPL:PPgPg 9-øii—7v—–nipasMjoadlar—qv—Esmmr—jzv—Doala—Bv—joadlar—AHv—Eau-Mjoadlar—–v—7ts1orf—––T—zyyauil

ny—orlmdor—nr—-ocra,— ymruionr—trc—lncomh—aFusaionr— or—patdip,—lmw/auilg—Hotwaindnfot—b8:8K4 TS8kLS88g

Sg 9-øii—7v—Vttf—5v—Esmmr—jzv—–nipasMjoadlar—qv—Dtdd—A5v—Eau-Mjoadlar—–v—7ts1orf—––T—zyyaui—nyorlmdor—nr—sartd—lncomh—ptrcdorf—or—p,.asorlmdortahou—i,.a— —3rnrMorlmdorMca.arcari(—cotwaiou.tioaril—0oip—.aso.pastd—orlmdor—salolitruag—Hotwaindnfot—b88bK—4kT 6PL :bg

6g Amluaddo— zv—jtitdo— 5v—Eotrupo— 9v—Eoftxxo—Gv—Dtd1tr—5Qv—9osnro— 5Av— Ustluasst—9v—)onuotsn—HvUasstrroro—zT—zyyaui—ny—orlmdor—nr—sartd—lncomh—trc—msou—tuoc—ptrcdorf—or—allariotd—p,.asiarlonrg5h—B—–,.asiarl—b88SK—8T6kSL6P g—

:g Usoacwasf—)zv—<nnhtrl—–5v—Eo/dlht—B5v—Gtwador-—RBv—Hnspnmi—Aaal—zBT—9ncomh—saiarionr—w,orlmdor—ht,—ca.arc—nr—causatlac—.dtlht—.nitllomhg—Aaitwndolh—b88bK—kIT IbL Ikg

8g Usoacwasf—)zv—1tr—Emsar—Av—Eo/dlht—B5v—<nnhtrl—–5T—Crlmdor—orusatlal—lncomh—satwlns.ionr—orcodmiorf—lafhari—or—pmhtrlT—z1ocarua—yns—orcosaui—hacotionr—ipsnmfp—p,.n-tdahotg—<ocra,—Crib88bK—kIT PbL PSg

bIg Vnfadxtrf—Av—Zo/dlist—Uv—jo/liar—A%jT—Halofr—trc— oh.daharitionr—ny—DGC7T—5—unh.miasoxacfdmunla—unrisnd—l,liah—ti—t—lmsfoutd—oriarlo1a—utsa—mroig—EA)—Aac—Crynsh—Hauol—At-— IIPK—PTPg

bbg Vnfadxtrf—Av—Jnay—EDv—Gafioar—BDv—1tr—cas—–nsli— C)v— 1tr—5llar—–v—Zo/dlist—Uv—jo/liar—A%T)nh.miasMtlloliac—fdmunla—unrisnd—or—usoioutdd,—odd—.tioarilg—Criarlo1a—)tsa—Aac— II:K—4kTbk bLbk 6g

b g Bnlé—GBv—7saddas—BT—jats—.tioari—ialiorf—ny—.nitllomh—da1adl—mlorf—tsiasotd—wdnnc—ftl—trtd,laslT)tr—0a—ismli—ipala—salmdil?—zhasf—Aac—B— II:K— PTPbILPb4g

b4g <rtml—%5v—Hst.as—z5v—%tfras—H7v—Zohhashtr—BzT—575)–z—CCT—5—la1asoi,—ny—colatla—udtlloyoutionrl,liahg—)soi—)tsa—Aac—b8:PK—b4T:b:L: 8g

bkg Vnfadxtrf—Av—1tr—cas—–nsliv—jo/liar—A%T—–,.asfd,utahou—orcaF—tl—t—innd—in—tllall—fdmnulaunrisndT—5—saisnl.auio1a—limc,g—)soi—)tsa— IIkK—:TGb L Gb 6g

bPg Gnllaiio—Jv—<daorMGnwwarptts—Jv—Doawolup—Dv—9ohip—Hv—HaUsnrxn—GT—zyyaui—ny—orlmdor—nr—sartd.nitllomh—haitwndolhg—5h—B—7p,lond—b8:6K— P TUSILUSkg

bSg Ro0tsco—5v—Gotxo—9v—zuadwtsfas—)5T—Crlmdor’l—oh.tui—nr—sartd—lncomh—istrl.nsi—trc—wdnnc—.sallmsaor—patdipv—nwaloi,v—trc—cotwaialg—5h—B—7p,lond—Gartd—7p,lond— II6K— 84TU86kLU8:kg

b6g Doawolup—DT—Gartd—.nitllomh—istrl.nsiT—Usnh—udatstrua—in—uptrradl—trc—.mh.lg—<ocra,—Cri—b88SKk8TbS kLbS4bg

b:g Ynmrf—HEv—7tmdlar—5%T—Criassadtiac—ayyauil—ny—tdcnliasnra—trc—.dtlht—.nitllomh—nr—.nitllomhaFusaionrg—5h—B—7p,lond—b8:4K— kkTU :LU4kg


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b8g <pmso—Gjv—9isoacas—%jv—Doawolup—DT—zyyauil—ny—ydn0—stia—trc—.nitllomh—orit-a—nr—colitd—imwmdts.nitllomh—istrlyasg—5h—B—7p,lond—b86PK— :Tb k8Lb Sbg

Ig 9itrinr—E5v—Doawolup—DT—zyyauil—ny—.–—nr—.nitllomh—istrl.nsi—w,—sartd—colitd—imwmdag—5h—B—7p,londb8: K— k TUPkkLUPPbg

20151129_quarkx manuscript.qxp_proefschrift M Hoekstra 29/11/15 21:38 8

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Computer-assisted potassiumregulation in the intensive care

Part IV


university of groningen acute metabolic changes in ... file111 effect insulin on renal potassium...

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