THE ELECTROLYTE CONTENT OF SKELETAL MUSCLE IN CONGESTIVE HEART FAILURE; A COMPARISON OF RESULTS WITH INULIN AND CHLORIDE AS REFERENCE STANDARDS FOR EXTRACELLULAR WATER 1

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Abstract
Biopsies of the gastrocnemius were taken in 4 non-cardiacs with congestive heart failure, after a constant infusion of inulin had been admd. for 30 hrs. in the cardiacs and 6 hrs. in the controls. In 3 additional cardiacs biopsies were taken without prior inulin infusion. In normal patients 49 g. of extracellular water were associated with 100 g. of fat-free muscle solids; using "Cl space" as the reference standard, this value for extracellular water was 18% higher. When a constant correction for non-diffusible Cl was applied, equivalent to 1 mM of Cl/100 g. of fat-free solids, the extracellular water content was 4% greater than with the inulin. In the 3 patients with heart failure the Cl/inulin ratio was 0.95 and the chloride-1/inulin ratio was 0.87. The true value for extracellular water is not evident from the present study. If one accepts the "Cl space" or a "corrected Cl space" as the reference standard for extracellular water, it can be shown that the cardiac with fixed heart failure has a loss of intracellular K and a gain of intracellular Na. With inulin as a standard, there is no change in the intracellular electrolyte composition in heart failure from the normal.