The acquired immunodeficiency syndrome

Very high prevalence of gestational diabetes in Vietnamese and Cambodian Postwar mortality among former prisoners of war of the Japanese. women. J.c.G. Doery, K. Edis, D. Healy, S. Bishop, C. Tippett... III George Freed. 113 Captopril overdose. Stewart R. Graham, Richard O. Day, Mark Hardy III Problems with referrals. D.V. Arndt 114 The acquired immunodeficiency syndrome. D.O. Crompton III Paul Nisselle. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114 Anthony J. Pinching. . . . . . 112 G.T. Somers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114 Bowel-floraalteration: a potential cure for inflammatory bowel diseaseand W.G.E. Straffon . . . . . . . . . . . . . . . . . . . . . . . . . . 114 irritable bowel syndrome? Robert McEvoy 112 A significant illness that was produced by the white-tailed spider, Lampona High-cost anaesthetic technology. John Williamson. . . . . . . . . . . . . . . . . . 112 cylindrata. Myrle Gray. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114 Blindness and the finger cherry tree. Frank P. English, Yale Bennett . . 112 Papanicolaou smear-test screening in pregnancy. What is the clinical significance of reduced manganese and zinc levels in Suzanne Abraham, Derek Llewellyn-Jones 116 treated epileptic patients? M. Akram, C. Sullivan, G. Mack, History of tuberculosis among Aborigines. Carol Metcalf, N. Buchanan 113 Derek Yach... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116 Very high prevalence of gestational diabetes in Vietnamese and Cambodian women To the Editor: Universal screening for gestational diabetes in a general antenatal population has revealed that the prevalenceof gestational diabetes among Vietnamese-and Cambodian-born patients is sevento eight-times the prevalence in Australian-born women. A total of 934 women who presented at the Monash Medical Centre Antenatal Clinic for routine care was screenedfor the presenceof gestational diabetes. The screening procedure consisted of a venous plasma-glucose measurement, one hour after a 75-g glucose load by mouth, which was ingested in the non-fasting state. If the onehour plasma glucose level were greater than 8.1 mmollL, a full IOO-g oral glucose-tolerance test was performed after an overnight fast. I Glucoseconcentrations weremeasured in capillary whole-blood specimensthat werecollectedone and two hours after the glucose load. Gestational diabetes was diagnosed if the one-hour glucose level were greater than 9.5 mmollL or the twohour glucose level were greater than 8.1 mmollL. All glucose measurements were performed on a YSI glucose analyser. A review of the patients by country of birth indicated that 9070 (84 women) of patients were born in Vietnam and 6% (56 women) of patients were born in Cambodia. Australian-born women comprised only 40070 (374 women) of the total clinic population. The prevalence of gestational diabetes in the Vietnamese-born patients was 14.3% (12 of 84 women) and in the Cambodian-born patients was 16.1% (nineof 56women). This is markedly higher than in the Australian-born women, who showed a prevalence of gestational diabetes of 2.4% (nine of 374 women). The remaining 420 women were born in 61 other countries; none of these groups of migrants showed a prevalence of gestational diabetes that exceeded 3% of subjects. This retrospective study of the prevalence of gestational diabetes in a general antenatal population of a major public hospital suggeststhat women of Indochinesebackground are at a greatly increased risk of this diseaseand therefore of fetal complications. Consequently, such patients should be screened as a routine for the presence of gestational diabetes even in practices where universal screening is not performed. J.C.G. Doery, MD K. Eelis, BSc(Hons) D. Healy, FRACOG S. Bishop, DipAppSci (Nurs) C. Tippett, FRACOG Departments of Biochemistry and Obstetrics & Gynecology Monash Medical Centre 246 Clayton Road, Clayton, VIC 3168 I. O'Sullivan lB, Mahan CM, Charles D, Dandrow RV. Screening criteria for high risk gestational diabetes patients. Am J Obstet Gynecol 1973; 116: 895-900. Captopril overdose To the Editor: We would like to report two cases of captopril overdose. In mid 1988, two men presented to our hospital within two hours of ingesting 20 to 30 25-mg captopril tablets, 20200mg theophylline tablets and greater than 100 g of ethanol. The ingestion was part of a suicide pact. These agents were available readily as one patient was hypertensive and the other was asthmatic. At presentation, both men were hypotensive (blood pressure, 80-90 mmHg systolic) and tachycardic(heart rate, 120-140 bpm). One patient was markedly-intoxicated and stuporous. Treatment with Haemaccel colloid was initiated and was followed by nasogastric aspiration. Fifty grams of activated charcoal with 500 mL of 20% mannitol solution were administered by way of a nasogastric tube to purge the gastrointestinal tract and to bind as much active drug as possible (the binding characteristics of captopril to charcoal currently are unknown). The cardiovascular and neurological status were monitored closelyin both men. Investigationsthat wereperformed on admission to hospital revealed a raised creatinine level of 0.15-0.17 mmollL in both men. A full blood count, liver-function test-results, sodium, potassium, chloride, urea and glucose levels, a chest x-ray film and an electrocardiogram were normal. The patients' progress was marked by a rapid return to normal of all abnormal parameters. A satisfactory blood pressure and urinary output was achieved in both men with intravascular volume expansion alone, without recourse to inotropic or specific renal-vasodilator agents. The tachycardia settled more slowly, the time-course being consistent with the half-life of theophylline. Creatinine levels had returned to normal values within 24 hours. At the time of hospital admission there were no reports of captopril overdose in the literature; however, while researching this letter we noted a report by Augenstein detailing a similar situation. I The major feature in our cases and in that of Augenstein was hypotension; additionally, in our case, the reversible change in serum creatinine measurements was notable. In spite of the oftenprofound effect of angiotensin converting-enzyme inhibition on the cardiovascular system in normal volunteers, our patients' condition responded rapidly to supportive care and they suffered no long-term sequelae as a result of their overdose attempt. We suggest that the management of overdose with angiotensin converting-enzyme inhibitor primarily is supportive. Initially, as much drug as possible should be removed from the intestine while an adequate blood pressure and urinary output is maintained. This is accomplished with nasogastricaspiration that is followedby purgation with 500 mL of 20% mannitol and absorption with 50 g of activated charcoal, with circulatory repletion, initially with colloidal solutions then with crystalloid solutions as required. Some patients may require inotropic support or renalvasodilator therapy. The close monitoring of potassium levels is wise in view of the known propensity of angiotensin converting-enzyme inhibitor agents to produce hyperkalaemia. Dialysismay be of use, particularly in patients with poor renal or hepatic reserves, as captopril shows both extensivehepatic metabolism and significant renal excretion of the unchanged parent drug. Stewart R. Graham, MB BS Ricbard O. Day, FRACP Mark Hardy, MB BS St Vincent's Hospital Victoria Street, Darlinghurst, NSW 2010 1. Augenstein WL. Captopril overdose resulting in hypotension. JAMA 1988; 259: 3302-3305.