334 M. Parini: Hypochloruria associated with hypovolemia

was extremely heterogeneous, the association between a low urinary Clu and hypovolemia was unaffected by renal function, dopamine (at renal dosage), diuretic, mode of ventilation and acid-base status. This suggests that Clu reflects distal tubular function inde- pendently of glomerular and proximal tubular condi- tions. This hypothesis is supported by the hypo- kaliemia/kaliuresis pattern observed in 9 patients. Interestingly 2 of these were treated with spirono- lactone and one (patient 8) had the same pattern prob- ably indicating a high endogenous aldosterone activity.

In conclusion, patients in ICU presenting with Clu ~< 20 mmol. 1 - t and Nau ~> 20 mmol. 1 - 1 or twice the C1 u value may be hypovolemic and only the chloride value should be taken into account in the as- sessment of the extracellular volume.

References

1. Goldberg M (1981) Hyponatremia. Symposium on body fluid and electrolytes disorders. Med Clin North A m 65:261

2. Guyton AC (1976) Textbook of medical physiology, vol 1. Saunders, Philadelphia, p 243

3. Mann RL, Carlon GC, TurnbuU AD (1981) Compar ison of elec- tronic and manometr ic central venous pressures. Crit Care Med 9:98

4. Maxwell MH, Kleeman CR (1972) Clinical disorders of fluid and electrolyte metabolism, vol 1. MacGraw-Hill , p 95

5. Shoemaker WC, Appel PL, Bland R, Hopkins JA, Chang P (1982) Clinical trial of an algorithm for outcome prediction in acute circulatory failure. Crit Care Med 10:390

Dr. M. Parini Depar tment o f Critical Care Medicine University Hospital Limoges France

Book review

R. W. M. Baldwin, G. C. Hanson. The Critically I11 Obstetric Patient. London: Farrand. 1985. 550 pp., £38.80. ISBN 1-85083- 000-2

Most obstetrics deals with normal women who have normal babies. We stand back watching them have their children and going home with little help f rom the obstetrical services. Now and then, how- ever, somebody becomes very ill and then all our skills are required. It is during this t ime that a team approach is best used with the con- sultant obstetrician as the gubernator. It is therefore appropriate this volume comes from a team of 22 experts including the two au- thors who are an obstetrician and a physician in charge of intensive care at Whipps Cross Hospital in London. The book contains much that is useful but is perhaps extended in some areas unnecessarily. It starts with the physiological aspecks o f pregnancy where the infor- mat ion is very patchy. Some systems are dismissed in just a page whilst others go on for many pages and so editorial direction is per- haps needed there. The second section on moni tor ing brings to- gether a lot of material which would be otherwise diverse for the obstetrical team to find. Perhaps some of the monitor ing of the

fetus was unnecessary in a book of this nature. It jars to see the newer spelling of the fetus with a diphthong being used here instead o f the more classical spelling. The third section deals with the gen- eral management of the critically ill patient whilst the fourth part o f the book deals with special events; chapters on cardiac arrest, se- vere hypertension, and fulminating pre-eclampsia are provided while infection, respiratory failure, thrombosis , renal failure and haemoglobinopathy problems are all well dealt with. Throughout , the emphasis is on management of both the mother and the fetus, an outlook which differs f rom many other volumes dealing with this subject. There is a slight air of dating o f this volume. Many of the references go back a long way and some of the therapies used would probably not find a place in a Western labour ward, for in- stance the use of chloroform and tricloethylene. This book is re- commended to residents in obstetrics, anaesthesia and intensive care. It may be the only source material they will get for informa- tion about the pregnant woman and her fetus with such medical problems. It should be used as a background book to read between events and to unders tand the reasoning behind treatments; it is re- commended to all obstetrical department libraries.

G. Chamberlain (London)