Salt Deprivation Research Articles

Clinical usefulness of determination of circulating 17-hydroxycorticosteroid levels.

THE NUMEROUS clinical and laboratory techniques that have been devised to study the functional activity of the various endocrine glands give ample testimony to the difficulty of critically evaluating endocrine function. For the estimation of the adequacy of adrenal function various metabolic processes related to effects of adrenal steroids may be studied. Some of these are the ability to excrete a water load, determinations of serum electrolytes, and observation of the blood sugar during fasting. Urinary 17-ketosteroids are in part derived from adrenal secretions but show a relatively poor correlation with adrenal function. 1 Techniques are also available for the measurement of the urinary excretory products of the 17,21-dihydroxy-20-ketone steroids, but problems related to the relative proportions degraded and excreted unchanged present themselves in the evaluation of such data. 1 Salt deprivation and insulin tolerance tests lack specificity and are laborious and potentially dangerous. The eosinophile response to adrenocorticotropin (ACTH) has been extremely useful

Multiple arteriovenous aneurysms of soft tissues and bone (pelvis and vertebrae) resulting in cardiac failure

A case is presented of a 34-year-old man who was hospitalized because of a three-month history of dependent edema and orthopnea. A diagnosis of rheumatic valvulitis was entertained, based upon the patient's age, the obvious signs of right and left heart failure, and a high pulse pressure. The absence of a murmur of aortic insufficiency in the presence of Corrigan's pulse prompted the consideration of arteriovenous fistula. Murmurs were heard in the lower vetebral and posterior pelvic regions and x-ray examinations of these areas revealed numerous lytic lesion. The coincidence of the pelvic murmurs and osseous lysis led to the clinical diagnosis of angiosarcoma with arteriovenous fistulas and resultant heart failure. An unusual low-salt syndrome, owing to salt deprivation and mercurial diuretics, was present. He expired five weeks after admission. Autopsy disclosed an extraordinary cardiac hypertrophy and multiple communications between the left hypogastric artery and the left common iliac vein. A very large aneurysmal sac was found occupying most of the posterior pelvic cavity. Extending posteriorly were dilated vessels which entered the pelvic and vertebral bones to form loculated, interconnected, intraosseous vascular channels. Evidence is presented which suggests that these vascular lessions are developmental anomalies. When one recalls that arteries and veins have a common embryonic origin from a capillary plexus, lying in close proximity to large vascular trunks, it is quite surprising that abnormal vascular communications do not occur more frequently. An alertness to this possibility may prompt the more frequent discovery of deeply hidden arteriovenous fistulas in those cases of decompensated heart disease in which the physical signs do not explain adequately the clinical findings.

Forced high caloric, low protein diet and the treatment of uremia

Many of the symptoms of so-called acute uremia are due to overloading the body with salt and fluids. Water restriction and salt deprivation are essential in the treatment of anuria. It is shown that catabolism of the body proteins and urea production can be greatly reduced if the patient's caloric requirements are met with carbohydrates and fat. It is emphasized that the patient should not be allowed to eat as little as he wants but that he should be persuaded or even forced to take the high caloric diet (Borst), hence the term forced high caloric diet. It is demonstrated in several of the cases reported herein that urea excretion (and production) can be reduced to 2 to 5 gm. per twenty-four hours. The patient's serum potassium may be lowered by this diet. Severe intoxication, infections, crushing injuries or necrosis may, however, cause a rapid rise in blood urea and potassium. Some patients were first seen after severe uremia and overhydration had already developed. In those patients dialysis with the artificial kidney or peritoneal dialysis improved their condition so that they were able to take the high caloric diet. Although there is no need to give protein to a patient with acute uremia so long as his caloric requirements are covered, the patient with chronic uremia should be given approximately 20 gm. of protein per day. This is well under the limit of 40 gm. generally advocated in this country, except by Kempner. With rice, butter, sugar, ice cream, potatoes, vegetables and fruits a satisfactory diet is possible. Some suggestions for the diet have been presented. It is the author's impression that patients with chronic, severely impaired kidney function may live longer and more comfortably when using this diet.