THE RELATIVE IMPORTANCE OF DIETARY SODIUM CHLORIDE AND WATER INTAKE IN CARDIAC EDEMA

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Abstract
On a diet containing less than 1 g. of NaCl daily, 22 patients with edema of congestive heart failure were investigated and an additional 8 patients were studied on the hospital cardiac general diet containing 3 g. of NaCl. Total daily urinary Na and Cl excretions were observed with varying fluid intakes. These studies indicated that the net loss of Na and of edema in patients with cardiac failure is greater when a diet is given containing less than 1 g. rather than 3 g. of NaCl. The net loss of Na and of edema is also greater when patients are encouraged to take 3000 ml. of fluid daily rather than be restricted to the customary 1500 ml. There seems to be little added benefit from at-temping to force fluids above 3000 ml. It is suggested theoretically that the fundamental object of the regimen described to treat cardiac edema is the maintenance of a low ratio of Na intake to water intake rather than a low Na or a high water intake per se. This concept provides a basis for evaluation of the relative importance of dietary salt and water in this regimen, and it accounts quantitatively for the fact that restriction of salt to low intakes is more readily effective in relieving cardiac edema than forcing fluid to very high levels.