Lessons of the month: Pyroglutamic acidosis: long-term paracetamol and a high anion gap.

An 84-year-old woman presented with confusion and Kussmaul respiration. She had a history of urosepsis, renal impairment and osteoarthrosis. The venous blood gas showed a marked metabolic acidosis with a high anion gap.

Variability in thyroid function test requests across general practices in south-west England.

Background: The number of thyroid function tests (TFTs) performed in the UK and other countries has increased considerably in recent years. Inconsistent clinical practice associated with inappropriate requests for tests is thought to be an important cause for this increase.

Aim: To study the extent of variability in requests for TFTs from general practices.