Clin Med
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When offering treatment to a patient with capacity they should be informed of the risks and benefits of therapy and consent should be obtained. For patients without capacity, treatment is given in their 'best interests'. Achieving and assessing capacity to consent for treatment in the presence of acute illness can be difficult and especially so in patients suffering with acute stroke. This article presents patients' and doctors' perspectives on assessing capacity to consent to thrombolytic therapy for stroke.
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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.