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The electrolyte content of paraffin-stimulated, whole, mixed saliva obtained from patients with congestive heart failure is characterized by lower sodium, lower chloride, and higher potassium concentrations than saliva of normal subjects (1). Since these data suggested possible increased adrenal cortical activity in patients with heart failure, desoxycorticosterone acetate (DCA) was administered to nineteen normal subjects. It also seemed of interest to study additional pharmacological and physiological mechanisms that may play a role in the regulation of salivary electrolyte concentrations. Thus, the aims of this communication are to present: 1) Data on normal salivary concentrations of sodium, chloride, and potassium; 2) data relating to physiological mechanisms regulating the concentrations of salivary electrolytes; and 3) the effects on salivary electrolytes of ard methods of statistical analysis were employed (3); the "t" test was used to determine the statistical significance of mean differences between groups, and the method of "paired differences" was employed in evaluating the effects of pharmacologic agents on the electrolyte concentrations of saliva.Ten mgm. DCA in oil were injected intramuscularly, daily, for 5 to 15 days into normal subjects who received a regular diet and 10 gm. supplemental salt by mouth per day. Duplicate collections of saliva were collected on consecutive days both before and during the administration of DCA in order to test the reproducibility of the values for salivary electrolyte concentrations. The concentration of potassium was not measured in one of these subjects.Twenty-nine pairs of observations were made on the effect of 6 mgm. of subcutaneously-administered pilocarpine on the salivary electrolyte concentrations in subjects without cardiac disease. Thirty minutes after the injection of pilocarpine the subject began to chew paraffin again, and 30 ml. of saliva were collected (usually in about 10 minutes).Two ml. of Mercuhydrin® were injected intramuscularly into 10 patients with congestive heart failure and on a low salt diet. Collections of saliva were made at the time of administration, and at 1Ih, 3, and 24 hours, respectively, after the injection of the mercurial diuretic.Fifteen experiments on nine normal subjects on a regular salt diet were performed in which saliva was collected in two successive 10-minute periods in order to compare the salivary electrolyte concentrations during varying rates of flow. RESULTS Normal concentrations of salivary electrolytesFor the 73 control subjects on a regular salt diet, including the 16 values obtained from our earlier studies (1), the normal salivary concentrations of sodium, chloride, and potassium are 26.4 + 11.8, 29.0 + 8.8, and 19.7 ± 3.9 mEq. per L., respectively. 246

Clinically suspected hypomagnesaemia was confirmed in 21 patients over 12 months; all patients had been exposed to either short-term vigorous diuretic treatment or moderate-dosage long-term treatment. Magnesium depletion was compounded by a hospital diet surprisingly low in magnesium, a local soft water supply, and, in some patients, high alcohol intake. Common presenting symptoms included depression, muscle weakness, refractory hypokalaemia, and atrial fibrillation refractory to digoxin treatment. The administration of magnesium supplements resulted in prompt improvement of all symptoms particularly in the case of refractory atrial fibrillation.Chronic low-grade magnesium deficiency from diuretic treatment is more common than published reports suggest. Older patients are at risk, particularly those who have excessive alcohol intake, a diet low in magnesium, or a soft water supply.

In congestive heart failure the urinary excretion of sodium and chloride following the administration of sodium chloride is decreased as compared with the normal (1-4). Similarly, the sweat concentration of sodium chloride has been shown to be lower than normal in cases of congestive heart failure (5). To explore the frequency of these disturbances of electrolyte excretion it seemed of interest to study the concentrations of electrolytes in the saliva of patients with congestive heart failure on a low-salt regimen and on a regular salt intake. Similar control studies were performed on non-cardiac subjects. EXPERIMENTAL Twenty-nine observations were made on 27 congestive heart failure patients receiving one gram of sodium chloride per day in their diet. There were 13 studies on 11 cardiac failure patients on a regular diet containing 10 grams of salt per day. Of these 11 cardiac patients on the regular diet four received supplemental sodium chloride (4 grams daily for periods up to 16 days).Twelve control observations on ten non-cardiac subjects receiving the salt-poor regimen were obtained, while 16 non-cardiac subjects on the regular diet were studied. METHODSSaliva was collected in the morning from the fasting patient who chewed paraffin for 15 to 20 minutes, yielding about 30 cc. of saliva.Whole, mixed saliva was analyzed. Sodium and potassium concentrations were obtained with an internal standard Perkin 52A flame photometer. Chloride concentrations were measured by the Van Slyke-Hiller iodometric method (6).Standard methods of statistical analysis were employed (7). RESULTS

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