[Epidemiology and prognosis of hyperosmolar state in the elderly].

Objective: We studied elderly patients admitted for hyperosmolar state (HS) to evaluate current outcome of HS and identify prognosis factors associated with mortality.

Study Design: A clinical retrospective study in an eight bed ICU.

Patients And Methods: Eighteen over 65-year-old patients admitted with a serum osmolality greater than 325 mOsm/kg were reviewed.

[Diagnosis by blood smear of a fulminant pneumococcemia complicating a myeloma].

Introduction: During a pneumococcal septicemia, the direct revelation of bacteria on a blood smear is rare and has been mainly described in splenectomised patients.

Observation: A 62 year-old non-splenectomised man suffering from myeloma died, a few hours after his admission to emergency department, from a fulminant pneumococcemia, the diagnosis of which had been rapidly evoked on the examination of a blood smear showing numerous Gram positive diplococci.

Comments: This observation highlights the potential severity of pneumococcal infections in patients suffering from altered humoral immunity and the diagnostic interest, in this case, of a systematic routine blood smear permitting rapid initiation of appropriate treatment.