Arthritis caused by Mycoplasma salivarium in hypogammaglobulinaemia.

contributing to the fall in plasma albumin concentration may have included at least two factors-namely, rehydration with crystalloid solutions as the major factor and reduced synthesis of albumin associated with impaired liver function. Previous alcoholism may have contributed. Finally, Gundersen9 showed that in healthy diabetics intravenous insulin may directly cause a reduction in the plasma albumin concentration. Our cases suggest that plasma osmotic pressure may be an important variable in patients treated by large volumes of crystalloid infusions and that further studies are required to elucidate mechanisms of pulmonary oedema in such patients. ADDENDUM-Since this paper was first submitted crystalloid infusions in diabetic ketoacidosis have been the subject of some debate.10-"3 The existence of the phenomenon of acute pulmonary oedema is not seriously disputed, but the mechanisms and frequency of its occurrence are controversial. We were unable to make any assertions about the likely mechanisms in our patients or what made them unusual, "at risk" patients. It would be surprising if the condition was limited to young ketoacidotic patients; in older patients heart failure or pneumonia is probably often diagnosed in error.