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.

The benefit of evolving multidisciplinary care in ALS: a diagnostic cohort survival comparison.

Background: Care for people with amyotrophic lateral sclerosis (ALS) has altered at King's College Hospital over the last 20 years. The clinic has been a multidisciplinary, specialist, tertiary referral centre since 1995 with a large team with integrated palliative and respiratory care since 2006. We hypothesised that these changes would improve survival.