THE MANAGEMENT OF REFRACTORY EDEMA IN HEART FAILURE

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Abstract
Restoration of responsiveness to mercurial diuretics may be accomplished by the production of a hyperchloremic acidosis in such refractory patients. Patients with resistant edema due to heart disease were studied. Observations were made of fluid balance, plasma pH, and plasma and urine electrolyte concentrations. Pretreatment with combinations of acetazoleamide (Diamox), and NH4CL resulted in hyperchloremic acidosis with plasma chloride concentrations as high as 129 meq/l. No untoward effects of the hyperchloremia or acidosis were observed. No significant diuresis occurred during this preparatory period. After cessation of acetazoleamide administration, mercurial administration consistently resulted in a good diuresis. Acetazoleamide inhibits mercurial effect when given simultaneously.

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