Excessive fluid retention related to cellulose ingestion: Studies on two patients

Abstract

Two female patients ages 35 and 31 years who had chief complaints of marked changes in weight with excess fluid retention were observed to remain edema-free (patient M.H.) for over 5 weeks on a low cellulose diet and (patient E.H.) for 9 weeks on a cellulose-free diet, with water intake unrestricted and sodium intake 90–160 mEq./day. The administration of short-chained methylcellulose (Cologel ® 30 ml. three times a day) resulted in a 14-lb. weight gain in 48 hours in patient M.H. and an 8-lb. weight gain in 24 hours in patient E.H. The excess fluid disappeared by 72 hours after the last dose of Cologel. Fluid retention was demonstrated on two occasions in both patients at different phases of the menstrual cycle. At the peak of fluid retention, the patients had visual aberrations, mental cloudiness, and poor coordination of some skeletal muscle actions. During administration of Cologel there was sodium and water retention, a 5–8 mOsm/Kg. increase in serum osmolality, and a 25–75 per cent decrease in urinary aldosterone excretion rate. Fluid retention could be prevented in patient E.H. on a selective diet containing some cellulose by restricting sodium to 25 mEq./day, or by restricting water intake to 500 ml./day. Patient E.H. had a 5-fold greater than normal increase in plasma renin activity in response to sodium restriction. Aldosterone excretion rate increased from 8.9 to 330−450 μ g. 24 hours with 3–4 days of sodium restriction. Free water clearance in patient E.H. was 25–50 per cent of normal. Reinstitution of cellulose-containing foods in the diet resulted in a return of the problem of fluid retention.