Raised amniotic fluid concentrations of alpha-fetoprotein in a twin pregnancy.

and the actual bicarbonate 16 6 mmol/l. To control the arrhythmia practolol 20 mg was given intravenously over 30 minutes. He was also given 30 units of insulin intravenously and 30 units intramuscularly. Later he became feverish and ampicillin was started. His condition rapidly improved with an immediate fall in the blood pressure to 140/100 mm Hg and the pulse rate to 130/min. The plasma glucose then fell to 10-6 mmol/l (191 mg/100 ml) with an actual bicarbonate concentration of 23 mmol/l. The patient remained normotensive (blood pressure 130/80 mm Hg) and his diabetes was controlled by Actrapid MC (28 units at 8 am, 24 units at 6 pm). The left hypochondrial mass was shown by intravenous pyelography and abdominal aortography to be a large, left suprarenal tumour. This proved to be a phaeochromocytoma (homovanillylmandelate 238 nmol/24 h). At laparotomy after combined alphaand beta-blockade,2 the diabetes being controlled by continuous glucose-insulin infusion, a suprarenal tumour weighing 500 g was removed. Chromaffin staining showed that it was adrenaline secreting. After the operation the patient required no further insulin and the homovanillylmandelate output returned to normal.