Clin Med
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A known alcoholic was admitted for a repeated episode of fits abolished by treating the patient's hypocalcaemia. Several mechanisms of hypocalcaemia in alcoholics have been described but in this patient coeliac disease was also diagnosed. Non-compliance with a gluten-free diet led to poor control of the disease, continued hypocalcaemia and an admission with a repeat seizure leading to death.
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CKD is common and its prevalence may be increasing. It carries with it a substantial cardiovascular risk but the vast majority of patients will never require dialysis. The minority requiring further investigation or complex management should be promptly identified and referred to a nephrologist. The remaining patients require lifelong monitoring in primary care and careful attention to their cardiovascular risk factors.