The prevention of edema in infants undergoingsulfonamide treatment

Abstract

I T HAD been noted for some time at the Children's Hospital that infants treated sulfonamides and adjuvant alkalies became edematous more often than might be expected from the incidence of pulmonary infections. Upon closer examination it was noted that even in the absence of frank pitting edema, many other infants made precipitous and appreciable weight gains, which were as rapidly lost upon recovery and cessation of therapy. It has long been a wellrecognized observation that patients pneumonia very frequently became edematous and a diuresis was hailed as the first sign of recovery. However, the advent of the sulfonamides this was noted more often in pulmonary infections and also, interestingly enough, was seen in other infections. The alkali in general use in the Children's Hospital, as elsewhere, was sodium bicarbonate. Because of the well-known importance of the sodium ion in water balance, it was decided to see whether the edema could be prevented by using alkalies with cations other than the sodium ion. Potassium citrate was chosen because of its high solubility and availability at the time. Without selection, alternating admissions requiring sulfonamide therapy were given either sodium bicarbonate or potassium citrate. The dosage of the sodium bicarbonate ranged from 0.28 to 0.42 Gin. per kilogram. The dose of potassium citrate ranged between 0.44 to 0.70 Gin. per kilogram. In the administration of the drugs the larger doses were given the smaller infants. After this series, a group of children were given a mixture of sodium bicarbonate and potassium citrate. This mixture contained .066 Gm. of potassium citrate and .033 Gm. of sodium bicarbonate in each cubic centimeter. The average dose was 0.42 Gin. of potassium citrate and 0.21 Gm. of sodium bicarbonate per kilogram of body weight. This mixture was used in an attempt to lessen the theoretical chances of toxicity due to the potassium ion and at the same time to obviate the production of edema due to excess sodium. A fourth group was given 10 per cent sodium lactate in dosage of 0.48 Gm. per kilogram of body weight as the alkalinizing agent. The apparent discrepancies in amount of alkali used do not really exist. This is made clear by stating the dosage in moles of cation used per kilogram of body weight. Examples of this are given in Table I. All the alkalies were given by mouth. Very few children were unable to take them in this manner. These infrequent patients are customarily given parenteral one-sixth molar sodium lactate. The pH of the urine was measured nitrazine paper three times a day. All the alkalies tried, in the dosages given, satisfactorily kept the pH of the urine between 7 and 7.5 or better,