SummaryAs Hartmann's solution is commonly used by anaesthetists, we surveyed a group of Part III FRCA candidates to establish their knowledge of its constituents and the purpose and metabolism of the lactate in solution. Of the 82 candidates surveyed only three (4%) accurately recorded the electrolytes and their concentrations in Hartmann's solution. Lactate was stated to be a source of bicarbonate by 52 (63%) and a source of glucose by 17 (21%). The descriptions of lactate metabolism were largely imprecise, none was complete and 24 (29%) of candidates offered no explanation. The constituents of Hartmann's solution and their concentrations are designed to match those of plasma, reducing ion and fluid shifts postinfusion. The lactate in Hartmann's solution is metabolised by both oxidation and gluconeogenesis, predominantly in the liver, and bicarbonate is generated by both processes over 1-2 h. Hartmann's solution is often regarded as the anaestheticpanacea of fluid resuscitation. This crystalloid formulation is routinely employed as the rehydration and maintenance solution of choice in the operating theatre. In discussion with colleagues it became apparent that knowledge regarding the concentration of the constituent ions and the metabolism of the lactate content varied widely. We therefore decided to assess the level of knowledge about Hartmann's solution amongst the wider anaesthetic community. MethodsWe obtained permission from The Royal College of Anaesthetists to survey candidates attending the Part III FRCA College course in February 1996. At the end of an afternoon lecture session, those present were asked to complete a voluntary and confidential questionnaire. The candidates were given no time limit for completing the task, but were instructed not to confer with each other, nor to refer to texts. The questionnaire (see Appendix 1) asked for the following information: 1 the constituents and their concentrations in 1 litre of 0.9% sodium chloride; 2 the constituents and their concentrations in 1 litre of Hartmann's solution; 3 the purpose of the lactate in Hartmann's solution; 4 the metabolism of the lactate in Hartmann's solution.In addition to the survey, we also reviewed the anaesthetic textbooks present in the anaesthetic library of The Royal London Hospital to establish the availability of 'source information' under the following headings: 1 Hartmann's solution -constituents, metabolism; 2 Ringer's lactate solution -constituents, metabolism; 3 lactate metabolism.

Risk factors for deep vein thrombosis and pulmonary embolism during pregnancy or post partum: a population-based, case-control study.

One of the hypotheses advanced to explain the processes underlying severe depression postulates a change in brain function due to an alteration in the distribution of cations across the neuronal membranes (Shaw and Coppen, 1966; Shaw, 1966). Electrophysiological evidence of abnormal function of pathways in the nervous system in depression has been obtained by the study of evoked cortical potentials (Shagass and Schwartz, 1966), but evidence of derangement in the distribution of cations between the cells and extracellular space has come only from “whole body” studies (Coppen and Shaw, 1963; Coppen, Shaw, Malleson and Costain, 1966; Shaw and Coppen, 1966).

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The results from a small series of persons suffering from alcoholism suggested that the amounts of water and electrolytes in their brains (obtained post mortem) differed from those of control and depressed individuals (Shaw, Frizel, Camps and White, 1969). Since publishing this work we have analysed brain tissue from a further series of alcoholic subjects, and in this paper we compare these findings with the original data from control and depressed groups.