Oral Contraceptives and Coronary Thrombosis

latrogenic Ulcers of the Small Intestine SIR,--We should like to report another possible case of ileal ulceration and perforation in a patient receiving enteric-coated potassium-chloride tablets but not chlorothiazide.In June, 1964, a woman aged 58 was diagnosed as having pemphigus vulgaris.This proved difficult to control and necessitated an initial suppressive dose of 210 mg.prednisolone and 120 units corticotrophin gel daily.Control was achieved and the steroids were gradually withdrawn during the following four months without recurrence of the pemphigus.Her serum potassium fell steadily during treatment despite constant administration of enteric-coated potassium-chloride tablets 1 g.twice daily in- creasing on 19 August to 2 g. -three times a day.It was suspected, and later confirmed, that she was not taking all her potassium and she dis- charged herself on 26 August with a serum potassium of only 2.7 mEq/l.She was warned of the possible consequences and by 2 Septem- ber her potassium was 5.1 rising to 5.5 mEq/l., suggesting that she was now taking the full dose of potassium chloride-that is 6 g. daily.At about this time she began to complain of vague lower abdominal pain associated with tenderness and diarrhoea.Her E.S.R., which tad varied from 25 to 45 mm. (Westergren), rose to 85 mm./hr.and has since fluctuated between 44 and 116 mm.On 1 November the pulse rate rose suddenly to 120 and she was mildly shocked.A gastrointestinal perforation was sus- pected and she consented to admission but re- fused operation.The haemoglobin fell to 58% and occult bloods were positive.Triamcino- lone was finally discontinued on 22 November but potassium chloride was continued.She gradually improved until on 10 December 1964, a barium enema revealed a fistula between the ileum and pelvic colon.A few diverticula were present in the colon.At no time during her illness were thiazide-type diuretics administered.