Treatment of edema by removal of body sodium by a cation exchange resin

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would remove clinically significant quantities of sodium in the feces of patients receiving low sodium diets. However, the reported experience on this aspect of resin therapy has been disappointing. lv2 In a recent appraisal of the clinical value of cation exchange resins Danowski3 concluded that they are of value in preventing sodium absorption by patients on moderate sodium intakes but will not remove sodium from the edema fluid of patients on low sodium diets. The results reported in the present paper are not in accord with that conclusion. The removal by a cation exchange resin of clinically significant quantities of sodium from the edema fluid of patients on low sodium diets is described. The pharmaceutical preparation used was resodec@t which is prepared from amberlite XE-96,@ a carboxylic cation exchange resin. Amberlite XE-96 is a pharmaceutical grade of amberlite IRC-50,@ a cross-linked, polyacrylic polymer with a cation exchange capacity of 10 mEq. per gm. of hydrogen form resin. Its exchange characteristics have been described by Kunin and Barrys4 Resodec is a mixture of the ammonium and potassium forms of XE-96 containing 1.6 mEq. of potassium per 10 mEq. of resin (1.3 mEq. per gm. of resin). It is a fine, white powder (100 to 200 mesh in size) and contains a flavoring agent and an agent to aid in its suspension in water.5 The feces are homogenized with water, and an aliquot containing approximately 5 mEq. of resin is stirred fifteen minutes with 40 ml. of normal HCl. The supernatant is separated by centrifugation and the residue washed four times with 30 ml. of water. The combined supernatant and washings are analyzed for sodium and potassium, and the quantities of these cations in the feces calculated. The residue, containing the resin now in the hydrogen form, is stirred thirty minutes with 40 ml. of normal NaOH. The supernatant is discarded and the residue washed six times with 30 ml. of water. The residue, containing resin now in the sodium form, is stirred fifteen minutes with 40 ml. of normal HCI. The supernatant is separated and the residue washed four times with 30 ml. of water. The sodium content of the combined supernatant and washings is determined. Since this quantity of sodium equals the resin present in the aliquot, the amount of resin present in the feces can be calculated. Analysis of feces containing no resin gives an apparent value of about 4 mEq. of resin per day. Resin added to feces can be quantitatively recovered. Sodium and potassium were determined with an internal standard flame photometer,6 urinary and serum chloride by the method of Sendroy as modified by Van Slyke and Hiller’ and dietary chloride as described by Van S1yke.s The digestion procedure of Wallace and co-workers9 was used for dietary sodium and potassium.