Treatment of the Low-Salt Syndrome in Congestive Heart Failure by the Controlled Use of Mercurial Diuretics

Abstract

The production of the low-salt syndrome in cardiac patients with refractory congestive heart failure is generally attributed either to fluid retention with electrolyte dilution or to excessive salt loss, induced by the frequent administration of mercurial diuretics. The former is often the important etiologic factor. In a study of a group of 25 refractory cardiac patients with normal plasma electrolyte patterns, a hyperchloremic acidosis was produced to restore a responsiveness to mercurial diuretics. During the mercurial-induced diuresis that followed, the urinary sodium concentration was significantly lower than the plasma sodium concentration in all instances. From these observations, a method of treatment of the low-salt syndrome, utilizing mercurial diuretics seemed feasible. This regimen was successfully carried out in two hyponatremic patients with return of plasma sodium to normal and striking clinical improvement.