CONGESTIVE heart failure that no longer responds with diuresis to mercurial injections usually carries a grave prognosis, often leading to progressive cardiac decompensation and death. This condition represents a real challenge to the practicing physician. It has become evident that a host of factors may be responsible for the development of this refractoriness. The irreversible trend of events in some cases turns out to be due to an unsuspected complication, such as myocardial infarction, pulmonary infarction, renal insufficiency, pneumonia, active rheumatic carditis, cerebral vascular accident, anemia, hyperthyroidism, infection, arrhythmias, or others.1 Occasionally, inadequate digitalization or insufficient sodium restriction may be responsible. However, a group of patients with so-called refractory heart failure continues a downhill course in the absence of these complications. It is becoming increasingly clear that this group ceases to respond to mercurials as a result of an electrolyte imbalance, the nature of which is variable and the
STAPLETON JF, HARVEY WP. HYPOCHLOREMIC ALKALOSIS INDUCED BY MERCURIAL DIURETICS IN CONGESTIVE HEART FAILURE: A Reversible Form of So-Called Refractory Heart Failure. AMA Arch Intern Med. 1952;90(4):425–434. doi:10.1001/archinte.1952.00240100002001
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