SUMMARY Severe abnormalities of plasma electrolyte concentrations were observed in 4 children who had massive hyperlipidaemia secondary to poorly-controlled, insulin-dependent diabetes mellitus. These electrolyte values were fallacious and invoked problems of clinical management, particularly with regard to fluid repla^ement. Each case is described and the interpretation of plasma electrolyte values in hyperlipidaemia is discussed.Moderately raised serum lipids and lipoproteins often are found in adults with diabetes mellitusI-3 and in diabetic children4-both before and after treatment.

T. Congenital tryptophanuria with dwarfism ('H' disease-like clinical features without indicanuria and general amino-aciduria): a probably new inborn error of tryptophan metabolism.

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haemolysis (which may affect the rate). Serum is fibrinogen-free, and it is simple to measure the viscosity of plasma and serum separately. We investigated the value of paired plasma viscosity and serum viscosity measurements in predicting the development of chronic rheumatic disease in a population with acute symptoms attending a special early-arthritis clinic. Patients, methods, and resultsWe investigated 115 consecutive patients attending a clinic specifically for patients with early rheumatic complaints. All had had symptoms for less than three months, and in most cases it was impossible to make a diagnosis at the initial attendance. The group was reassessed at a minimum six-month follow-up and a diagnosis established. Plasma and serum viscosities were estimated at first attendance and then related to the subsequent diagnosis. Blood was collected into two tubes; one plain, the other containing EDTA. Both samples were spun simultaneously and the viscosity of the supernatants measured on a Harkness viscometer under standard conditions. Normal plasma viscosity is 1-52-1-72 mPa s (cP) and normal serum viscosity 1-40-1-60 mPa s (cP).Plasma viscosity was raised in 72 patients, 35 of whom subsequently developed chronic arthritis (table). The remaining 37 did not develop chronic arthritis but had varied diagnoses, including polymyalgia rheumatica, synovitis associated with infection, etc. Only 29 patients showed raised serum viscosity. Of these, 28 subsequently developed chronic arthritis. The remaining patient had an underlying carcinoma of the bronchus.Of those patients with chronic arthritis, eight had Reiter's disease and 29 classical or definite rheumatoid arthritis (ARA criteria), of whom five were seronegative. Fifteen patients (eight with an increased plasma viscosity) included in the group with transient synovitis could have been diagnosed as possible rheumatoid arthritis by ARA criteria at presentation, but at sixmonth follow-up were completely asymptomatic. The diagnosis of infectionassociation synovitis was based primarily on a strong clinical history and where possible supported by appropriate laboratory tests. On occasions, however, diagnosis was based on a strong history alone, and we suspect that many of the "transient synovitis" group would also have had precipitating infection.From the clinical standpoint, plasma viscosity was normal in two patients who subsequently developed chronic arthritis, and serum viscosity in eight. Serum viscosity is highly specific in predicting subsequent chronicity but has a higher false-negative rate.

ReferencesLesch