Water and electrolyte balance during recovery from severe congestive failure on a 50 milligram sodium diet

The distribution of body fluids in congestive heart failure. III. Exchanges in patients during diuresis

The balance technic was applied in six studies of patients with congestive heart failure during the diuresis of their edema fluid. From the data so obtained changes in the extra- and intracellular phases of the body fluids were calculated, as well as transfers of sodium and potassium between the several phases and between the body and external environment. The results indicate that abnormalities of intracellular fluid exist in this condition.

Electrolyte studies in heart failure. II. Extracellular factors in the pathogenesis of congestive edema

Indirect metabolic studies and direct muscle biopsy studies have indicated diminution of intracellular electrolyte concentration during congestive heart failure explainable by extrusion of these electrolytes due to increase in osmolarity within the cells. Acute and chronic physical and circulatory stress in cardiac patients produced an elevation of plasma sodium concentration indicative of a concomittant increase in osmolarity of the extracellular fluid.

Potential role of potassium as a determinant of morbidity and mortality in patients with systemic hypertension and congestive heart failure

Prehistoric animals and humans consumed a diet low in sodium but high in potassium, and thus, evolutionary forces fostered the development of physiologic systems that conserved sodium and excreted potassium. With the advent of civilized societies, food cooking and processing have greatly increased the sodium but decreased the potassium content of the diet. However, there has been little time for physiologic systems to adapt. The resulting excess of sodium has been implicated as an important factor in the development of hypertension and congestive heart failure. This traditional focus on sodium has ignored the potential role that an inadequate dietary intake of potassium might play in the degenerative diseases of the heart, brain and kidney. Yet dietary potassium may be as powerful a determinant of cardiovascular morbidity and mortality as dietary sodium. In experimental and clinical hypertension, an increased intake of potassium (without a change in dietary sodium) can reduce blood pressure, may suppress the activity of the sympathetic nervous and renin-angiotensin systems, and can prevent the development of vascular injury; conversely, potassium depletion has been associated with an increase in stroke and sudden death. In patients with chronic heart failure, potassium can modify both the mechanical and electrical properties of the heart, it can exert diuretic effects, and it can reduce the frequency and complexity of potentially lethal ventricular tachyarrhythmias. Given this central role, the effects of many pharmacologic interventions on the morbidity and mortality of patients with hypertension or chronic heart failure can be enhanced or diminished by the effect that these treatments might have on potassium homeostasis.(ABSTRACT TRUNCATED AT 250 WORDS)

Exchangeable potassium content of the body in congestive failure; changes during treatment

The increase in body weight in congestive heart failure is generally attributed to the retention of sodium and water in the extracellular compartment. Important changes also occur in the intracellular space, particularly in the metabolism of potassium. The isotope-dilution technic permits more precise determination of the exchangeable potassium content of the body in congestive failure before and during diuresis. The results of 27 such determinations in 11 patients with congestive heart failure are correlated with the clinical status of the patient and the serum concentration.

Sodium, potassium and magnesium balance during recovery from congestive heart failure due to cor pulmonale and other heart diseases

Five cases of congestive failure due to varied causes were studied metabolically during recovery. The cases of cor pulmonale showed changes in cations and osmotically active base, similar to changes in heart failure due to other causes. A difference in the movement of water was noted between three of the present cases and the usual case of congestive heart failure.

Alterations in exchangeable sodium content, "sodium 24 space" and body weight during the treatment of congestive failure

Serial determinations of the exchangeable sodium content and sodium 24 (Na 24 ) space were made by the radioisotope dilution method in patients with congestive failure during the course of intensive therapy. In most instances, the decrease in body weight was too great to be accounted for solely on the basis of the change in sodium 24 space or exchangeable sodium content. This excess weight loss is attributed to loss of intracellular fluid.

The relationship of sodium retention and venous pressures to edema formation

Two patients with congestive cardiac failure were placed on a metabolic balance regimen and supplemental sodium chloride was administered. Weight changes in these patients could be closely correlated with the amount of sodium retention and appeared to be initially independent of brachial venous pressure thus supporting the concept that edema in congestive failure results from prinmary sodium retention rather than primary elevation in venous pressure.

Electrolyte Studies in Heart Failure

Muscle analyses for water, potassium, and chloride were made in 10 cardiac patients during and after congestive heart failure. The potassium content per unit of wet tissue during failure was 30.1 per cent less than that during compensation. The concentration of potassium in the intracellular water increased from 116 mEq. per liter to 151 mEq. per liter with compensation. Calculated extracellular water decreased, but no change in intracellular water per unit of tissue solids was found.