Scot Med J
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A patient is reported who developed lactic acidosis, hyponatraemia and features of the Wernicke-Korsakoff syndrome following long term excessive ingestion of beer and lager. Intramuscular thiamine caused a rapid correction of the lactic acidosis, and the hyponatraemia was corrected by intravenous therapy. On discharge after six weeks of intramuscular Parentrovite the patient still retained some chronic features of the Wernicke-Korsakoff syndrome.
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Alcohol-induced 'wet' or cardiac beri-beri is reported in two middle-aged males who consumed excessive amounts of beer. The high carbohydrate and satiety value of beer together with its low thiamine content places the alcoholic beer drinker at particular risk of thiamine deficiency.
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The factors determining the use of Section 31 admissions and reclassifications at a district psychiatric hospital were investigated prospectively over an eight month period. Thirty-six per cent of patients failed to meet the criteria laid down for full detention and, particularly with reclassification, Section 31 was invoked to secure treatment. While the Emergency Recommendation is not used as the legislators intended, a seven day detention order appears more relevant to modern psychiatric practice than the full detention procedure.
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Retrospective scrutiny of the documents authorising 240 consecutive emergency detentions to a Glasgow psychiatric hospital over a three-year period revealed that 15 per cent were incorrectly completed. Fourteen documents (5.8%) failed to meet a list of minimum requirements supplied by the Central Legal Office and were therefore invalid. ⋯ In practice, these documents were recognised at the hospital of detention and patients were either properly detained, informally admitted, or in three cases, discharged. It is suggested that doctors who make Emergency Recommendations without using the printed form should always discuss the wording of their letter with the receiving psychiatrist who should in turn be familial with the six minimum requirements of the Central Legal Office.