THE INFLUENCE OF MINERAL METABOLISM UPON NEPHROTIC EDEMA 1

Abstract

Water, Na, and Cl were retained or excreted during edema formation or remission in the proportions found in blood plasma, with little variation in the plasma concentrations. Potassium was practically always in balance. In a patient with impaired renal function, an increase of fluid intake from 1500 cc. to 2500 cc. caused a temporary diuresis, but a further increase to 3000 cc. produced even greater edema. Sweating produced in a patient with 70 pounds of edema fluid a blood and urine picture of dehydration, with low serum total base, low red cell K, and the disappearance of Na from the urine. Ingestion of KCl raised the red cell K and serum Na, and caused Na to reappear in the urine. Edema fluid acts as a reservoir of alkali. Adequate excretion of Na (and therefore of H2O and Cl) in nephrosis is apparently possible only when serum Na is normal or higher than normal. Factors which increase the serum Na may promote diuresis.