title: Prevalence and Implications of Abnormal Laboratory Results in Patients in the Terminal Phase of Life.
abstract: Pathophysiological changes at the end of life may affect pharmacokinetics of drugs. However, caregivers typically do not extensively monitor patients' laboratory parameters at the end of life.
  
  
  
  Our aim was to describe laboratory parameters of hospice patients in the week before death.
  
  
  
  A cohort study was conducted on available laboratory results in the week before death, including clinical chemistry and hematology tests.
  
  
  
  Laboratory data of 125 patients in a palliative care center were included, assessed at a median of 3 days before death. Eighty percent of patients had anemia and almost all had hypoalbuminemia (97%). Elevated levels of gamma-glutamyl transferase (gGT) were found in 75%, of alkaline phosphatase (ALP) in 60%, of aspartate aminotransferase (ASAT) in 60%, and of calcium (Ca) in 68%. Alanine aminotransferase (ALAT), bilirubin, sodium (Na), and potassium (K) were abnormal in from 8.8% to 36.0% of patients. A previous unknown poor kidney function was found in 60% of patients. Thirteen patients (22%) with a regular morphine prescription and one patient treated with a non-steroidal anti-inflammatory drug (NSAID) had severe kidney failure.
  
  
  
  Abnormal laboratory results were expected due to the pathophysiological changes that occur during the last phase of life. Remarkably, however, electrolytes (Na and K) were balanced even shortly before death. Estimated glomerular filtration rate (eGFR), reflecting the kidney function, seems the most clinically relevant laboratory parameter, because it may guide drug choice and dosing.
authors: 1 Palliative Care Centre , Laurens Cadenza, Rotterdam, the Netherlands .|2 Pain Expertise Centre, Erasmus MC-Sophia Children's Hospital , Rotterdam, the Netherlands .
authors: Anniek D
authors: AD
authors: Masman
authors: 2 Pain Expertise Centre, Erasmus MC-Sophia Children's Hospital , Rotterdam, the Netherlands .|3 Intensive Care, Department of Paediatric Surgery, Erasmus MC-Sophia Children's Hospital , Rotterdam, the Netherlands .
authors: Dick
authors: D
authors: Tibboel
authors: 1 Palliative Care Centre , Laurens Cadenza, Rotterdam, the Netherlands .|2 Pain Expertise Centre, Erasmus MC-Sophia Children's Hospital , Rotterdam, the Netherlands .
authors: Frans P M
authors: FP
authors: Baar
authors: 2 Pain Expertise Centre, Erasmus MC-Sophia Children's Hospital , Rotterdam, the Netherlands .|3 Intensive Care, Department of Paediatric Surgery, Erasmus MC-Sophia Children's Hospital , Rotterdam, the Netherlands .
authors: Monique
authors: M
authors: van Dijk
authors: 4 Hospital Pharmacy-Clinical Pharmacology , Academic Medical Centre, Amsterdam, the Netherlands .
authors: Ron A A
authors: RA
authors: Mathot
authors: 5 Department of Hospital Pharmacy, Erasmus Medical Centre , Rotterdam, the Netherlands .
authors: Teun
authors: T
authors: van Gelder
mesh_terms: D000410:Alanine Transaminase; D001219:Aspartate Aminotransferases; D015331:Cohort Studies; D006801:Humans; D015995:Prevalence; D013727:Terminal Care / Q000706:statistics & numerical data; D005723:gamma-Glutamyltransferase
chemical_list: D005723:gamma-Glutamyltransferase; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase