Migrating Intravenous Catheter

Abstract

Chopra and colleagues (11 July, p. 77) suggests the use of peritoneal dialysis for the treatment of pulmonary oedema after acute myocardial infarction. I would like to make the following comments. The authors do not mention whether their patients were given salt-free diets. Myocardial infarction may be followed by intense sodium retention which results in rapid gain of body weight unless sodium intake is restricted. (Dr. Chopra and colleagues do not mention what happened to body weight.) If the patients were allowed to go into positive sodium balance it is hardly surprising that diuretics were ineffective. The maximum doses of frusemide given (80 mg. in one case, 120 mg. in another, and 200 mg. in the other two) were quite small. Why were not higher doses of frusemide given? The authors do not mention whether the patients were kept in the sitting position in a cardiac bed. It would be unfortunate to subject patients with pulmonary oedema after myocardial infarction to peritoneal dialysis when the simpler methods of gravity, salt restriction, and high dose frusemide have not been used first.-I am, etc., M. I. M. NOBLE.