Effects of anorexia nervosa on bone density.

Sir, As arrhythmias occur when thrombolytics are administered, it is advised by Rawles (editorial, April Journal, p.l71) and by Hannaford and colleagues (April Journal, p.175) and elsewhere' that every doctor carrying thrombolytics outside hospital should also carry a defibrillator. I was not aware of this in 1992 when I considered participating in Hannaford and colleagues' study and it is not yet made clear in published drug advice.2 I would ask Hannaford and colleagues how many doctors in their study relied on the ambulance defibrillator rather than their own machine, and if any doctors administered thrombolytics in the absence of a defibrillator. If reperfusion can precipitate arrhythmias then other drugs that relieve ischaemia might produce arrhythmias during myocardial infarction. I would value further information on this, because drug administration can often be delayed until defibrillation facilities have arrived.