A HIGH FLUID INTAKE IN THE MANAGEMENT OF EDEMA, ESPECIALLY CARDIAC EDEMA. II. CLINICAL OBSERVATIONS AND DATA

Publisher Website
Google Scholar
Abstract
The details of the regime, which is based on renal function and water balance principles were published in 1942. Here, the method of study is described and the material from 626 separate periods of treatment of 402 cases observed in the 8 yrs. from 1933 through 1941 is analyzed, and general and specific observations are presented. In 80% of the periods of observation the avg. daily intake was from 3,000-5,000 ml. and in 13% a daily avg. of 5,500-7,500 ml. was attained; isotonic intraven. supplements were given freely. Such intakes were given, with the proper regulation of Na, to edematous patients with severe acute injury of the myocardium, marked narrowing or incompetence of the heart valves, advanced general vascular disease, eclampsia, and advanced nephritis with the nephrosis syndrome. This was often in the face of high venous pressures and low plasma proteins and in the presence on admission of such findings as acute pulmonary edema, convulsions or choked discs, a low fixed sp. gr. of the urine, or marked Cl or Na deficits. Such large intakes were not observed to "overwork the heart or over-burden the circulation," produce generalized edema or retard its disappearance even with high venous pressures or low plasma proteins, produce pulmonary edema or convulsions, produce so-called water-intoxication or "wash out" needed Na or. Cl, or hinder restoration of body-fluid vol. or the correction of the electrolyte pattern defects. On the contrary, such cases and conditions tolerated the high water intake of this regime with impunity and benefit, particularly the more edematous or "brine-logged" cardiac cases. Both immediate and late results seemed superior to those obtainable on accepted restricted fluid regimes (172 control observations). It was possible to reduce greatly the use of acid and mercurial diuretics and the clearing of edema was facilitated to such an extent that oppressive degrees of hydrothorax and ascites rarely required aspiration (11 times). In certain instances, the very high water intake was noted to be essential to the clearing of resistant edema (61 observations). A significant number of cases (39) that had remained disabled by their anasarca on restricted fluid regimes in competent hands were restored to useful activity on the high fluid regime. Through October 1944 the 5 yr. survival rate is 40% for 102 cases as compared with 27% in a recent study of 150 cases on an accepted restricted fluid regime.

This publication has 18 references indexed in Scilit: