Influence of digitalis on intracellular electrolytes in patients with congestive heart failure. Investigations on erythrocytes.

Abstract

1. For the purpose of studying intracellular electrolyte metabolism in patients with congestive heart failure and the effect of digitalis on them, sodium and potassium concentrations in erythrocytes in twenty-one patients with compensated heart disease or chronic congestive heart failure were measured. In 13 patients of these subjects, sodium and potassium concentrations in erythrocytes before and during administration of digitalis were measured. At the same time, sodium, potassium and aldosterone excretion in urine and venous pressure were estimated. 2. For determination of normal ranges of red cell Na, K concentrations by the method applied in the present study, 9 normal blood samples were obtained from healthy physicians and nurses. Their means and standard deviations are given next. Sodium concentration in serum is 143.8±2.88mEq/L. Potassium concentration in serum is 4.29±0.29mEq/L. Sodium concentration in red cells is 12.0±1.45mEq/L. Potassium concentration in red cells is 99.3±3.72mEq/L. 3. Sodium and potassium concentrations in serum and red cells before the onset of treatment in patients with congestive heart failure. i) Sodium concentration in serum was significantly decreased, whereas that in red cells was kept in almost normal range. ii) Potassium concentration in red cells was significantly increased along with the clinical grades of heart failure, whereas that in serum was kept in almost normal range. 4. Influence of digitalization on serum and red cell sodium and potassium concentrations in patients with congestive heart failure. i) Sodium concentrations in red cells in 9 of 10 patients were increased, whereas those in serum in 8 of 10 patients were not changed. ii) Potassium concentrations in red cells in all 10 patients were decreased to the normal range; on the other hand those in serum in 5 patients were increased, 3 were decreased and 2 were not changed. 5. One of the influences of therapeutic dose of digitalis on red cell electrolytes may be due to the direct effect of digitalis on erythrocytes (particularly on their membranes) especially in the early stadium of its administration, but during the late stadium with its maintenance dose, there may be some indirect effects due to haemodynamic improvement of congestive heart failure.