The Medical journal of Australia
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The adult population of a small Victorian town was interviewed for current analgesic consumption and the replies were validated by urine testing. One thousand four hundred and fifty-six subjects were ranked by stated analgesic consumption, and the 50 highest consumers matched for age and sex with non-consumers. Early morning urine specimens were collected and no significant difference in osmolality or white cell excretion rates was found between the two groups. It was concluded that the absolute risk of renal impairment on chronic analgesic consumers is low, and that patients on therapeutic regimens, including analgesics, may be reassured that any risk is minimal.
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A review if presented of the use of low-dose insulin infusion in the management of 58 episodes of severe diabetic hyperglycaemia. Neutral insulin in a dosage of 2-4 units per hour is infused via a paediatric giving set to achieve a sustained physiological elevation of insulin levels. This method is safe, simple and rapidly effective in lowering the blood glucose level, the mean rate of fall (62 mg/100 ml/hr, or 11% per hour) being unaffected by prior insulin therapy, acidosis or ketonuria. ⋯ Bicarbonate therapy is rarely indicated in the management of acidosis. No patient had cerebral oedema during treatment, and one elderly patient with extensive pneumonia and empyema died during the infusion. It is suggested that continuation of low-dose insulin infusion, together with 5% dextrose solution, after the plasma glucose level reaches 200 mg/100 ml, may hasten the clearance of ketones, preventing relapse.