Anaemia due to blood loss from the telangiectases of scleroderma.

Case 1. She was the tenth-born in her family and weighed 2.75 kg. (6 lb.) at birth. She also was fed on Ostermilk No. 2, reconstituted as follows: 2* measures Ostermilk No. 2+3* measures water+ 1 teaspoonful of sugar, four-hourly. Her initial sodium level was 194 mEq/l., potassium 7.1 mEq/l., and chloride 156 nIEq/l. The carbon dioxide combining power was 17 mEq/l., and the blood urea nitrogen was 198 mg./100 ml. Treatment was carried out as in Case 1, and within 48 hours her electrolyte values had returned to normal. Convulsions occurred repeatedly throughout that period despite anticonvulsant therapy and the maintenance of normal blood sugar and calcium levels. She died suddenly at 51 hours, however, and necropsy permission was refused. COMMENT In both cases hypernatraemia was caused by excessive administration of solute in relation to fluid intake owing to improper reconstitution of dried-milk formulae. In Case 1 the mother had prepared feeds, using double the powder content recommended , but she believed that one tablespoon contained one fluid ounce of water. In Case 2 the initial feeding history obtained seemed quite normal. It only became clear on specific questioning that the mother used the dried-milk scoop for measuring fluid in the belief that each scoop contained a fluid ounce of water. The feeding instructions issued by the manufacturers of three commonly used dried-milk preparations-namely, OstermiLk No. 2, full-cream Cow and Gate, and full-cream National Dried Milk-would be quite clear to most mothers (see Table), but none of those instructions make it absolutely clear that the measure supplied is for dried milk and not fluid. The National Dried Milk instructions do indicate that one fluid ounce is approximately two tablespoons and for that reason are the most explicit. It is probably quite fortuitous that in both cases Ostermilk No. 2 was the dried milk powder used, but further errors could probably be avoided if feeding instructions were even more simple than at present. Thus it should be made clear that the measure supplied is for dried milk only and not fluid, and that one fluid ounce is approximately equal to two tablespoonfuls. Make up with hot (boiled) (Full-cram) water to 4 oz. (Full-cream) for each feed (in level (1 oz.-2 tablespoons measures), 2j or 3 approx.), 3j or 4 We wish to thank Professor J. 0. Forfar for his advice and criticism, and Drs. J. W. Farquhar and W. M. …