[Should we switch from saline to lactated Ringer's solution? Limited benefits, medication warning system required]. / Moeten we over van NaCl 0,9% naar Ringer-lactaat?

In recent years, there has been a growing advocacy to implement the use of balanced solutions like lactated Ringer's solution instead of normal saline as fluid therapy in non-critically ill patients. Currently, evidence shows that there might be a limited benefit of the use of Lactated Ringer's solution over saline in both in critically ill and non-critically ill patients. Lactated Ringer's solution is, in contrast to saline, incompatible with blood products and various frequently used intravenously administered drugs. The use of these drugs in conjunction with lactated Ringer's solution therefore requires additional precautionary measures. A hospital-wide transition from saline to lactated Ringer's solution might be beneficial for a subset of patients. However, a medication warning system is required for safe implementation.

[Unusual causes of hyperprolactinaemia]. / Bijzondere oorzaken van hyperprolactinemie.

Pituitary adenoma is the main cause of hyperprolactinaemia; however, physicians should be aware that the pituitary is not always to blame. There are many other physiological and pathological causes for hyperprolactinaemia, and the contribution of stress, medication and the presence of macroprolactin should not be overlooked. We describe three patients - a 19-year-old female, a 28-year-old female and a 20-year-old male - in whom hyperprolactinaemia was due to medication use, physical stimulation of the nipple and a combination of macroprolactianaemia with a microadenoma, respectively. The first two case reports show that conducting a thorough patient history can prevent unnecessary imaging and laboratory costs. The third case illustrates that macroprolactinaemia and true hyperprolactinaemia may coexist. While early screening for macroprolactinaemia in an asymptomatic patient can save money, finding macroprolactinaemia in a symptomatic patient still warrants further workup.