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The earlier tetanus develops then the worse the outcome and the longer it takes to develop then the better the likely result.

The tetanus germs produce a poison or toxin which affects the nervous system.

The first symptoms are often restlessness and agitation which is then followed by spasm of the muscles.

The jaw muscles are often the first affected and so the patient has difficulty in opening the mouth — the old name for tetanus was lock-jaw.

Eventually all the muscles go into severe cramps or spasms and breathing may be affected and the patient may then die of lung or heart failure.

The modern treatment of tetanus is to sedate the patient heavily with massive doses of diazepam, a tranquilliser and a curare-like muscle relaxant drug used in anaesthesia.

A tracheotomy, or opening of the windpipe is made and the patient is put on a breathing machine and breathes artificially.

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Potassium is often given in the form of tablets particularly when taking large doses of diuretics.

Some newer drugs have a mild diuretic action and a potassium-sparing effect as well. These are often added to the diuretic to prevent the excretion of potassium and so no added potassium is necessary.

We now believe we have somewhat over-reacted to the reports about the need to add extra potassium when using diuretics.

When the diuretic is used to control high blood pressure, there is usually no need for extra potassium. It may be necessary in treating heart failure if digitalis is used as well.

In liver and kidney disease, regular blood tests, will determine whether potassium is low, and when the supplements are necessary.

Although there is little risk from taking extra potassium if it is not needed, the real problem is that the normal dose is six tablets daily. This extra load on top of those prescribed to treat the condition may make some people give all their tablets away or take a reduced dose.

Better patient compliance seems to go with fewer tablets and the less often they need to be taken during the day.

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