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Tetany following mercurial diuresis
SELECTED Casman, J. : Radiographic Demonstration Ingestion of a Litre of Water. Acta.
921
ABSTRACTS
clin.
of the Increase in belg.,2:113 (March-April),
Heart
Volume 1947.
After
Enlargement of the heart in persons who are heavy beer drinkers has been attributed to hydremia and to hypertension. An additional cause was suggested by Govaerts and Lequime, who found that drinking a liter of water was followed by an average of 20 per cent increase in the work of the heart. The possibility that the increased work is accompanied by enlargement of the heart was investigated by the author. Twenty subjects, selected at random from a radiologic outpatient department, were studied. An x-ray film of the chest in the frontal plane was made before and forty minutes after drinking 1.0 liter of water. The duration of exposure included a complete cardiac cycle so that the cardiac silhouette could be measured in diastole. The measurements of three diameters were recorded: transverse, upper left to lower right border, and upper right to lower left border. &4fter drinking the liter of water, these diameters were found to be increased by 5.31, 4.84, and 4.11 per cent, respectively. If the heart were spherical, an increase of 5 per cent in the diameters would indicate an increase of 15 per cent in the heart volume; when the increase in the diameters was maximum (10 per cent), the increase in heart voume would be 33 per cent. It is concluded that when absorption of liquid is excessive, it may lead to the marked cardiac enlargement which characterizes the “beer heart.”
LAPLACE. Marshall,
F. A. : Tetany
Following
Mercurial
Diuresis.
J. A. M. A. 133:1007
(April
S), 1947.
The author presents the case of a 60-year-old woman who had been treated over a period of five months for congestive failure by digitoxin and repeated mercurial intramuscular injections. The patient suffered recurrent episodes of congestive failure and nocturnal dyspnea, and had been vomiting in spells. During one of these attacks 06 failure, the calcium was 7.4 mg. and phosphorus, 5.5 mg. per 100 cubic centimeters. Mercurial diuretics (mersalyl and mercurphylline injections chiefly) had been given at intervals of three to ten days as required by edema and congestive failure. On three separate occasions, tetany followed the parenteral use of mercurial diuretics. The author stresses the need for thought on the mobilization and excretion of electrolytes other than the chlorides. Relief was obtained through the use of parenteral and oral calcium. It appears that tetany is more likely in patients who ordinarily have a borderline calcium deficiency, which is further reduced below this critical level by excessive diuresis.
BELLET. Krieger, V. I., and of Hypertension
Weiden, S.: and Toxemia
The V a 1ue of the in Pregnancy.
Cold Med.
Pressor Test in J. Australia 1:417
the Prediction (April S), 1947.
The authors report that in a series of 522 cold pressor tests performed during 200 pregnancies, all tests gave normal results in eighty-four instances; hyper-reaction to the cold stimulus occurred in one test only on each of thirty-one patients, and in more than one test on each of eighty-five patients. Of all patients whose cold pressor tests gave normal results, only thirteen developed hypertension in the later stages of their pregnancies. In four of these patients the hypertension was associated with pre-eclampsia. In those patients in whom only one test gave a result of the hyper-reactive type, half had a normal pregnancy; the other half developed either hypertensive toxemia or pre-eclampsia. When mild hyper-reaction occurred on more than one occasion, twenty-six of the eighty-five patients had a normal pregnancy, but forty-nine developed hypertensive toxemia, and ten had pre-eclampsia. In the hands of the authors, the cold pressor test has given consistent results throughout pregnancy in the majority of their cases, and erratic results have been the exception. The results of cold pressor tests performed two and twelve months after delivery are valuable in assessing the prognosis of subsequent pregnancies. Those patients who still show hyperreaction twelve months after delivery should probably be classified as hypertensive. In the, cases in which the hyper-reaction response is replaced by a normal response some time after delivery,
921
ABSTRACTS
clin.
of the Increase in belg.,2:113 (March-April),
Heart
Volume 1947.
After
Enlargement of the heart in persons who are heavy beer drinkers has been attributed to hydremia and to hypertension. An additional cause was suggested by Govaerts and Lequime, who found that drinking a liter of water was followed by an average of 20 per cent increase in the work of the heart. The possibility that the increased work is accompanied by enlargement of the heart was investigated by the author. Twenty subjects, selected at random from a radiologic outpatient department, were studied. An x-ray film of the chest in the frontal plane was made before and forty minutes after drinking 1.0 liter of water. The duration of exposure included a complete cardiac cycle so that the cardiac silhouette could be measured in diastole. The measurements of three diameters were recorded: transverse, upper left to lower right border, and upper right to lower left border. &4fter drinking the liter of water, these diameters were found to be increased by 5.31, 4.84, and 4.11 per cent, respectively. If the heart were spherical, an increase of 5 per cent in the diameters would indicate an increase of 15 per cent in the heart volume; when the increase in the diameters was maximum (10 per cent), the increase in heart voume would be 33 per cent. It is concluded that when absorption of liquid is excessive, it may lead to the marked cardiac enlargement which characterizes the “beer heart.”
LAPLACE. Marshall,
F. A. : Tetany
Following
Mercurial
Diuresis.
J. A. M. A. 133:1007
(April
S), 1947.
The author presents the case of a 60-year-old woman who had been treated over a period of five months for congestive failure by digitoxin and repeated mercurial intramuscular injections. The patient suffered recurrent episodes of congestive failure and nocturnal dyspnea, and had been vomiting in spells. During one of these attacks 06 failure, the calcium was 7.4 mg. and phosphorus, 5.5 mg. per 100 cubic centimeters. Mercurial diuretics (mersalyl and mercurphylline injections chiefly) had been given at intervals of three to ten days as required by edema and congestive failure. On three separate occasions, tetany followed the parenteral use of mercurial diuretics. The author stresses the need for thought on the mobilization and excretion of electrolytes other than the chlorides. Relief was obtained through the use of parenteral and oral calcium. It appears that tetany is more likely in patients who ordinarily have a borderline calcium deficiency, which is further reduced below this critical level by excessive diuresis.
BELLET. Krieger, V. I., and of Hypertension
Weiden, S.: and Toxemia
The V a 1ue of the in Pregnancy.
Cold Med.
Pressor Test in J. Australia 1:417
the Prediction (April S), 1947.
The authors report that in a series of 522 cold pressor tests performed during 200 pregnancies, all tests gave normal results in eighty-four instances; hyper-reaction to the cold stimulus occurred in one test only on each of thirty-one patients, and in more than one test on each of eighty-five patients. Of all patients whose cold pressor tests gave normal results, only thirteen developed hypertension in the later stages of their pregnancies. In four of these patients the hypertension was associated with pre-eclampsia. In those patients in whom only one test gave a result of the hyper-reactive type, half had a normal pregnancy; the other half developed either hypertensive toxemia or pre-eclampsia. When mild hyper-reaction occurred on more than one occasion, twenty-six of the eighty-five patients had a normal pregnancy, but forty-nine developed hypertensive toxemia, and ten had pre-eclampsia. In the hands of the authors, the cold pressor test has given consistent results throughout pregnancy in the majority of their cases, and erratic results have been the exception. The results of cold pressor tests performed two and twelve months after delivery are valuable in assessing the prognosis of subsequent pregnancies. Those patients who still show hyperreaction twelve months after delivery should probably be classified as hypertensive. In the, cases in which the hyper-reaction response is replaced by a normal response some time after delivery,