The Correction of Electrolyte Deficits in Cardiovascular-Renal Disease

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Abstract
In a discussion of this multifaceted problem, mention is made of the salt-losing syndrome in patients with advanced nephritis or with terminal hypertension. It is pointed out that such patients lose excessive amounts of Na because of the inability of the renal tubules to adequately perform osmotic work in reabsorbing Na from the glomerular filtrate. Like otherwise untreated Addisonians, the salt-losers require supplementary Na salts to maintain Na balance. K losers also exist, and one should be on the lookout for them especially in two situations: (1) cardiacs and nephritics, with edema previously responsive to treatment, who become refractory to treatment, and (2) patients with far advanced kidney disease, some of whom become spontaneous K losers. The mechanism by which K deficiency develops is discussed for each of these categories. The problem of hyponatremia developing in cardio-renal patients with edema is a serious one and requires careful administration of Na salts, at the risk of making the edema worse. In some instances, the simultaneous administration of NaCl solution and of a mercurial diuretic has overcome the difficulty. In badly degenerated or near-terminal cases, the heroic use of corticotropin (ACTH, in doses of 15 to 25 U q 6 hours for 10-12 days) has been a life-saving measure, resulting not only in loss of edema (spontaneous diuresis occurring either during the course, or after discontinuation of corticotropin), but also in correction of hyponatremia, without the use of Na supplements. Concomitant adjuvant measures and the precautions observed during its administration are discussed in detail. Finally, the importance of simultaneous correction of plain water deficits along with replacement of necessary electrolytes in cardio-renal patients who develop gastro-intestinal or surgical complication is emphasized. In such patients, the best end results were obtained with the use mainly of hypotonic and isotonic, rather than hypertonic salt solutions.

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