800
BRITISH MEDICAL JOURNAL
been followed up for 10 months by PJH. There is no clinical evidence of cardiovascular disease or renal impairment. The chest x-ray film and electrocardiograph are both normal.
Comment It appears that as a result of the administration of betamethasone together with a low-dose ritodrine infusion this patient developed fluid retention with pulmonary oedema and right-sided cardiac failure. It has been suggested that patients developing pulmonary oedema while taking fenoterol may have an underlying cardiac lesion, particularly an obstructive cardiomyopathy, which would be aggravated by beta-sympathomimetic drugs.' Patients to be subjected to a combination of glucocorticoids plus sympathomimetic drugs should be screened for cardiac lesions before treatment. In those undergoing treatment a careful watch for fluid retention and cardiorespiratory symptoms should be maintained.
creatinine) respectively. When the amines were determined by radioenzymatic assay using COMT, with separation by thin-layer chromatography, noradrenaline excretion was 21 ± 3 nmol/mmol creatinine (313 +4-5 ,tg/g), and adrenaline 10±2 nmol/mmol creatinine (161±+3-2 lg/g). The results of the COMT assay are within the normal range (table). Urinary noradrenaline determined by a different radioenzymatic method (PNMT-based assay) was similar to the COMT result (table). Total metanephrines were grossly raised in eight out of the ten cases, and blanks were high with an unusual brown colour. VMA excretion, however, was normal (table). There was no relationship between apparent amounts of catecholamines or metabolites in urine, determined by non-specific methods, and the dose of labetalol taken.
Urinary noradrenaline and adrenaline (measured by fluorimetric and radioenzymatic methods), metanephrines and vanillyl mandelic acid (measured spectrophotometrically) in ten patients taking labetalol Case No
'Liggins, G C, and Howie, R N, Pediatrics, 1972, 50, 515. 2
Kubli, F, Proceedings of the Study Group on Pre-Term Labour, Royal College of Obstetricians and Gynaecologists, October 1977, p 218. London,
assay NA +A
(nmol/mmol
1 2 3 4 5 6 7 8 9 10
(Accepted 30 June 1978)
David Lewis Northern Hospital, Liverpool P J HAYES, MB, MRCP, senior medical registrar
Fluorimetric creatinine)
RCOG, 1978.
Department of Obstetrics and Gynaecology, University of Liverpool, Liverpool L69 3BX. H R ELLIOTT, MRCOG, lecturer in obstetrics and gynaecology U ABDULLA, MRCOG, senior lecturer and consultant obstetrician and gynaecologist
16 SEPTEMBER 1978
COMT assay NA A (nmol mmol
creatinine)
622 2931 3934 3266 2174 927 2456
8
PNMT assay NA
Total
VMA metanephrines (nmol!mmol ( ,umol rrmmol (nmol/mmol creatinine) creatinine) creatinine)
2112 1525 3930
21 27 21 29 17 12 18 10 18 17
7 19 20 11 3 8 9 12
15 17 11 20 23 9 7 19 15 39
232 1999 3012 1466 1596 309 1282 917 2471 4650
1 6 2-1 1 3 2-0 2 1 1-4 1-6 2 1 09 1 5
BRITISH MEDICAL JOURNAL
been followed up for 10 months by PJH. There is no clinical evidence of cardiovascular disease or renal impairment. The chest x-ray film and electrocardiograph are both normal.
Comment It appears that as a result of the administration of betamethasone together with a low-dose ritodrine infusion this patient developed fluid retention with pulmonary oedema and right-sided cardiac failure. It has been suggested that patients developing pulmonary oedema while taking fenoterol may have an underlying cardiac lesion, particularly an obstructive cardiomyopathy, which would be aggravated by beta-sympathomimetic drugs.' Patients to be subjected to a combination of glucocorticoids plus sympathomimetic drugs should be screened for cardiac lesions before treatment. In those undergoing treatment a careful watch for fluid retention and cardiorespiratory symptoms should be maintained.
creatinine) respectively. When the amines were determined by radioenzymatic assay using COMT, with separation by thin-layer chromatography, noradrenaline excretion was 21 ± 3 nmol/mmol creatinine (313 +4-5 ,tg/g), and adrenaline 10±2 nmol/mmol creatinine (161±+3-2 lg/g). The results of the COMT assay are within the normal range (table). Urinary noradrenaline determined by a different radioenzymatic method (PNMT-based assay) was similar to the COMT result (table). Total metanephrines were grossly raised in eight out of the ten cases, and blanks were high with an unusual brown colour. VMA excretion, however, was normal (table). There was no relationship between apparent amounts of catecholamines or metabolites in urine, determined by non-specific methods, and the dose of labetalol taken.
Urinary noradrenaline and adrenaline (measured by fluorimetric and radioenzymatic methods), metanephrines and vanillyl mandelic acid (measured spectrophotometrically) in ten patients taking labetalol Case No
'Liggins, G C, and Howie, R N, Pediatrics, 1972, 50, 515. 2
Kubli, F, Proceedings of the Study Group on Pre-Term Labour, Royal College of Obstetricians and Gynaecologists, October 1977, p 218. London,
assay NA +A
(nmol/mmol
1 2 3 4 5 6 7 8 9 10
(Accepted 30 June 1978)
David Lewis Northern Hospital, Liverpool P J HAYES, MB, MRCP, senior medical registrar
Fluorimetric creatinine)
RCOG, 1978.
Department of Obstetrics and Gynaecology, University of Liverpool, Liverpool L69 3BX. H R ELLIOTT, MRCOG, lecturer in obstetrics and gynaecology U ABDULLA, MRCOG, senior lecturer and consultant obstetrician and gynaecologist
16 SEPTEMBER 1978
COMT assay NA A (nmol mmol
creatinine)
622 2931 3934 3266 2174 927 2456
8
PNMT assay NA
Total
VMA metanephrines (nmol!mmol ( ,umol rrmmol (nmol/mmol creatinine) creatinine) creatinine)
2112 1525 3930
21 27 21 29 17 12 18 10 18 17
7 19 20 11 3 8 9 12
15 17 11 20 23 9 7 19 15 39
232 1999 3012 1466 1596 309 1282 917 2471 4650
1 6 2-1 1 3 2-0 2 1 1-4 1-6 2 1 09 1 5
