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September 1951

METABOLIC PROBLEMS ARISING IN THE MANAGEMENT OF CONGESTIVE HEART FAILURE

Author Affiliations

ST. LOUIS

From the Department of Internal Medicine, Washington University School of Medicine, and the Unit I (Washington University) Medical Service, at the St. Louis City Hospital.

AMA Arch Intern Med. 1951;88(3):387-394. doi:10.1001/archinte.1951.03810090118012
Abstract

THREE patients who received conventional therapy for heart failure at the St. Louis City Hospital regained compensation but died within a few days without apparent cause. Anorexia, lethargy, and, eventually, stupor preceded the death of each. Analysis of their records and clinical course suggested that an electrolyte imbalance had been precipitated during the treatment of the cardiac failure. Later, when similar patients were treated in a comparable manner, acidosis was discovered and dramatically corrected by the judicious use of sodium lactate. This experience led us to study the blood chemical pattern in patients with congestive heart failure before and during treatment with digitalis, ammonium chloride, mercurial diuretics, and a low-salt diet.

METHOD OF STUDY  Twenty-four patients in severe congestive heart failure were studied during the winter months when environmental temperatures could be controlled. Most of these patients had hypertensive or arteriosclerotic heart disease, or both. An attempt was made to

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