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[Case Report Comment] The importance of being rare

Sick children can have electrolyte abnormalities rarely seen seen by nephrologists who care for adults. In The Lancet, Detlef Bockenhauer and colleagues1 report a case with huge levels of derangement. In 1999, Webster and Kulkarni observed that metabolic alkalosis was more common than acidosis in critically ill patients,2 but many clinicians remember Kussmaul respiration in metabolic acidosis more readily than the hypercapnic response to alkalosis. As this case shows, severe alkalosis can be life threatening.

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