Canadian Medical Association journal
-
Grief following perinatal loss is just as debilitating as that following the death of an older person and may not be completely resolved for years. The physician's role in assisting parents following perinatal loss is one of a sympathetic listener and compassionate informant, but each category of perinatal loss--miscarriage, stillbirth, neonatal death and sudden infant death syndrome--requires a somewhat different approach. To be of assistance, physicians must understand the normal process of grief and the differences between the reactions of mothers, fathers and siblings. The advent of liberal attitudes to family visiting in perinatal units has helped parents better understand perinatal illness, and appropriate management in the event of perinatal death can greatly benefit the family.
-
Case Reports
Hypokalemic metabolic alkalosis caused by surreptitious vomiting: report of four cases.
Four women, aged 22 to 40 years, presented with severe hypokalemia and metabolic alkalosis. Three had related neuromuscular symptoms. ⋯ Three patients excreted sodium and potassium primarily with bicarbonate and had an alkaline urine; the fourth patient excreted these cations primarily with an organic anion and had an acid urine (pH 5.5). Since self-induced vomiting may be a common method of weight reduction in young women, recognition of this characteristic urine electrolyte pattern will assist in the rapid diagnosis of hypokalemia and metabolic alkalosis of obscure cause.