Considerations of Renal, Hepatic, and Extremital Arteriovenous Differences in Concentration of Radiomercury of a Mercurial Diuretic 1

Abstract

Mercurial diuretics are employed extensively today in the management of congestive heart failure, but the mechanism by which elimination of electrolytes and water is increased is not thoroughly understood. Furthermore, the metabolism and pharmacodynamics of mercury are only partially known despite the numerous investigations into the diuretic action of mercury. The majority of these studies have been concerned principally with clinical observations on the comparative value of various mercurial preparations, time of onset and quantity of diuresis, efficacy of the preparation in the management of edematous states and toxicity. The anatomic changes in the kidney appearing as a reaction to mercury have been adequately studied, but the physiologic renal changes are not so well understood. drin 8) labeled with radioactive mercury 4has been under study in this laboratory. Observations have been made of the simultaneous concentration-time course of the radiomercury in the serum of the blood from a femoral artery, right renal vein, hepatic vein and an extremital vein and in the urine collected directly from the renal pelvis and urinary bladder. It is the purpose of this presentation to report certain aspects of these data. MATERIALS AND METHODSThese studies were conducted on seven subjects from the Charity Hospital; in five, right renal venous catheterization was performed and in two, hepatic venous catheterization (Tables I and II). No subject had received a mercurial diuretic within five days prior to the study. All studies were made at least ten hours postprandially, but no effort was made to regulate diet or intake of water.In three subjects the urine was collected with ureteral catheters,5 by bilateral catheterization in Subject Nos. 1 and 3 and by unilateral catheterization in Subject No. 2; in the other four vesical catheterization was employed. Catheterization of the right renal vein or of a hepatic vein according to the technic of Cournand and Ranges (1) was performed under fluoroscopic control. The position of the catheter was substantiated fluoroscopically at the termination of the study and in three subjects by measuring renal extraction of para-aminohippurate as well. Five per cent dextrose in distilled water was the infusing fluid through the catheter, the quantity admin3The sodium salt of methoxyoximercuripropylsuccinylurea with theophylline, prepared with radiomercury in this laboratory by