these patients receiving a mean dose of contrast material of 106 mL (65 g) had overt acute renal failure for which treatment was contemplated. This is consistent with the findings reported by D'Elia et al' referenced in the letter of Dr Taliercio and col¬ leagues. D'Elia et al found no relation between the dosage of contrast mate¬ rial and the incidence of acute renal failure. In a subset of 29 azotemic patients (serum creatinine levels of 1.5 mg/dL or greater), five (17%) required treatment for overt renal failure following angiography.As we pointed out in our article, those patients with borderline renal function are at a high risk of develop¬ ing overt renal failure with even a small fall in creatinine clearance. We were unable to demonstrate any sin¬ gle or multiple factors that would identify the third of patients who will experience a fall in creatinine clear¬ ance following angiography.We therefore believe that angiogra¬ phy if indicated should not be with¬ held from a patient with a borderline renal function, but that their renal function should be monitored after angiography prior to surgery or other invasive procedures. Diabetics"1 dealt with the use of different carbohydrate sources to alleviate hypoglycemia.Twenty grams of D-glucose was recommended to treat hypoglycemicreactions. A list of foodstuffs containing 20 g of D-glucose was given to be used in the absence of commercially available D-glucose preparations.This list of alternative glucose sources included a 2.5-oz Hershey milk chocolate bar. The choice of a chocolate bar perpetuates the misconception that glucose from different foodstuffs will produce similar glycemic excursions.Our calculations show the 2.5-oz (70-g) chocolate bar contains 39 g of sucrose. This supports the assumption that this candy bar contains 20 g of glucose. However, a look at studies published by Otto et al2 in 1973 shows that the glycemic response to 25 g of carbohydrate taken as milk chocolate is approximately 30% of the response to glucose.We assume that the studies by Otto et al used chocolate produced in the European style. The composition of this chocolate is similar to that pro¬ duced in this country.3 In fact, Hershey's "European bar" contains 8% more carbohydrate than their "milk chocolate bar." Allowing for varia¬ tions in chocolate composition (by weight, milk chocolate bars contain 38% to 56% sucrose and 4% to 6% lactose), the assumption that 39 g of sucrose taken as a chocolate bar will produce the same glycémie rise as 20 g of D-glucose cannot be correct.We recognize the importance of the contributions made by our colleagues and urge them to extend their stud¬ ies.
