Various carbohydrates and a variety of widely used medicines interfere with the generally used laboratory methods for determining inulin and para-aminohippuric acid (PAH). When these pitfalls are not recognized, false measurements of inulin and PAH clearances, which represent glomerular filtration rate and renal plasma flow respectively, are obtained. When performing these tests a careful history of dietary habits and oral drug therapy must be taken.
of venous and capillary sampling, but it would have been interesting to have had two groups, one in which capillary sampling preceded arterial sampling and one in which it was done afterwards. Our data did not show a variation in the white cell count, and I wonder what mechanism Dr Shohat proposes for his observed rise during and after lumbar puncture. These points emphasise the difficulties in establishing a reference range of white blood count values for infants, particularly preterm infants, and in interpreting results by comparing them with published ranges. Application of the International Committee for Standardisation in Haematology guidelines for the standardisation of blood specimen collection procedures for reference values is obviously impractical. but it is clear that the method of sampling does
The target he sets is 35% of total energy without prejudicing growth or producing an unpleasant diet. Your readers might be interested in some preliminary findings of dietary intake at 18 months in a sample of 170 Hong Kong Chinese infants who are participating in a longitudinal study of growth and nutritional inter-relationships from birth to 5 years.Fat contributed about 30% of total daily energy consumption at 18 months. Most infants were then eating a diet of rice, fish, meat, and vegetables. Butter and high fat desserts were rarely given and ice cream only occasionally consumed. Energy intake was 0-414 MJ/kg/day, very similar to energy intake in recent studies from Canadian" (0-401 MJ) and Australian-3 children (0 418 MJ) of the same age. Our infants enjoyed excellent health and were growing and developing normally.In Hong Kong even with its obvious western influences the traditional Chinese diet in early childhood is low in total fat and cholesterol and saturated fats. As children grow older, however, the situation is likely to change as ubiquitous 'fast foods' increase their stranglehold on children's diets. It remains to be seen whether the very low fat intake of the early years in any way influences health in the long term especially in relation to cardiovascular diseases. ReferencesTarlow Educating medical students about death and dying Sir, I read with interest the article by Black et al, which points out the need to address the stressful feelings medical students and physicians have about dying and death.' The authors propose a course with objectives varying from identifying the dying patients' and family needs and their dealing with grief, to clearing away barriers set up by physicians surrounding death. A course of this type would no doubt improve a physician's ability to deal with death and dying, and would be helpful to their dying patients and their families. However. I feel the course proposed lacks one more important objective: obtaining permission for a necropsy and feedback to the family about the necropsy findings.The information gained from a necropsy, and properly presented to the family, may relieve the guilt that is a consequence of most deaths, provides assurance that the patient received proper medical care, and facilitates the grieving process. >4 As Hill and Anderson point out, the necropsy not only gives the physician the benefit of learning from his or her own experience, but also enables the medical student to accept the fact of death as an inescapable part of caring for the sick. intravenous infusion of arginine hydrochloride-which is used also to study growth hormone, glucagon, and insulin release2 3-has been described as safe and free of immediate or delayed untoward effects. Transient renal dysfunction, hypophosphataemia, and hyperkalaemia have, however, been described after arginine administration to normal subjects.'When reviewing arginine acidification tests performed in our clinic, we observed a significant progressive increase in plasma urea concentrations in children wi...
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