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July 14, 1951


JAMA. 1951;146(11):1030-1031. doi:10.1001/jama.1951.03670110050016

A recent report by Lown, Salzberg, Enselberg, and Weston1 throws further light on the long-recognized relation between potassium metabolism and the cardiac effects of digitalis. Ten patients in congestive heart failure served as subjects in this investigation. The threshold of mild toxicity to rapidly acting cardiac glycosides was determined during a control period and following procedures designed to induce a depletion of potassium.

Criteria of toxicity were based on electrocardiographic findings of ventricular extrasystoles, impairment of auriculoventricular conduction, or alterations in the pacemaker. The gross potassium balance was determined by changes in urinary potassium excretion. One of four patients given mercurial diuretics after pretreatment with ammonium chloride showed an increased urinary potassium excretion and an increased sensitivity to acetyl strophanthidin, while two others showed no significant change in potassium excretion and no signs of digitalis poisoning. In the fourth patient, the threshold for ouabain toxicity after mercurial diuretics was