Administration of large doses of L-lysine monohydrochloride at meal times has proved to be an efficient method, free of significant side effects, for the production of a hyperchloremic acidosis to restore responsiveness to mercurial diuretics in cardiac and cirrhotic patients with refractory fluid retention. Results obtained in a group of 14 patients are presented and advantages of L-lysine monohydrochloride over previously available acidifying chloride salts are discussed.
Rapid alteration of plasma, electrolyte concentrations during dialysis with the artificial kidney may be associated with changes in the electrocardiogram and in cardiac function. In this study, the electrocardiographic changes encountered during 33 hemodialyses are described and correlated with abnormal electrolyte patterns and their correction.
The relationhip between water and total solute excretion following mercurial administration has been previously studied in normal human subjects during superimposed water and solute diureses. It is the purpose of the study to determine the solute/water relationships in the mercurial diuresis produced in water-deprived patients with edema from congestive heart failure. The results indicate that in such patients, the diuresis produced has the relationship of a simple osmotic diuresis. The clinical implications are discussed.IN EXPERIMENTS on normal human subjects and laboratory animals, the variations in the concentration of urine solutes have been described during osmotic diuresis.'-8 The present concept of the mechanism for the production of urine of greater solute concentration than plasma has been defined by Smith and associates2 4, 7 and reviewed by Welt9 10 and is based on measurements of solute excretion (expressed as osmolal clearance) and the relationship of this excretion to the rate of urine flow during such diureses. The resulting concept is that of a fixed and maximal removal of solute-free water from the distal tubular fluid to produce a concentrated urine in the setting of maximal antidiuretic hormone (ADH) activity.It has been shown that the mercurial diuresis of normal subjects when superimposed on an osmotic or water diuresis satisfies this principle of a relatively fixed and maximal free water reabsorption.6 7 The finding by Grossman and co-workers1' of a phasic variation in free water reabsorption during mercurial diuresis in normal subjects receiving pitressin, It is the purpose of the present study to report the patterns of solute and water excretion in mercurial diuresis in patients with congestive heart failure, and to relate these findings to those obtained in normal human subjects in the above experiments. It is hoped that such data will permit estimations of the relationship between fluid and solute loss during such diureses in the clinical setting.
METHODSeven men with congestive heart failure were selected for study. All had an elevated venous pressure, cardiomegaly, and edema at the time of the experiment. All were receiving maintenance doses of digitalis and none had received any diuretic for at least 72 hours prior to the study. There had been no oral or parenteral intake for at least 12 hours prior to the study.An indwelling Foley catheter was inserted and urine collections were made with bladder compression, without irrigation, at intervals of 15 to 25 minutes. Venous blood was obtained without stasis at the time of each urine collection in 2 patients and at 1-to 2-hour intervals in the other patients. The subjects were recumbent throughout the study.Urine volume, flow rate (V), and urine osmolality were determined on each specimen, the latter by means of a Fiske Osmometer (freezing point). Total
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