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Attitudes to companion animals were surveyed among 50 patients and staff at a day care hospice. Dog visits were welcomed by all but two. Of the 37 patients studied, only seven had a companion animal, often their closest companion. Many more would like to keep an animal, but were prevented by age, frailty or accommodation restriction.

The hyperosmolar non-ketotic diabetic syndrome, first reported in 1957,' is being diagnosed with greater frequency.' Several cases have been reported of this syndrome being precipitated by treatment with diuretics, especially thiazide diuretics and frusemide.3-9 Diuretic treatment lasted from 15 days4 to 4 years" before the syndrome developed. We reviewed the case notes of a consecutive series of 11 patients with the hyperosmolar non-ketotic diabetic syndrome to find out how often diuretic treatment precipitated it. The criteria used for diagnosis were severe hyperglycaemia (blood glucose greater than 30 mmol/l (541 mg/100 ml)), absence of ketoacidosis, dehydration, variable neurological signs, including depressed sensorium or frank coma, and serum osmolarity above 340 mOsm/kg (calculated using the formula: osmolarity (mOsm/kg) 2 x (serum sodium + potassium) +blood glucose +blood urea). Case report One week before admission a woman aged 59 years was started on treatment for symptomless hypertension with Moduretic (amiloride 5 mg and hydrochlorothiazide 50 mg) two tablets daily. There was no family history of diabetes and no glycosuria. Soon after starting treatment she became tired, weak, thirsty, and had polyuria. On admission she was afebrile, drowsy,