Mechanism of Diuresis: Alterations in the Specific Gravity of the Blood Plasma With Onset of Diuresis in Heart Failure

Stewart, Harold J.

doi:10.1172/jci101189

Cited by 6 publications

(1 citation statement)

References 9 publications

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“…Interpretation of the significance of plasma proteins in heart failure should only be made in the light of the state of fluid balance of the patient, according to Stewart (27), and as these patients were not followed in this regard, no comment should be made upon the proteins.…”

Section: Discussionmentioning

confidence: 99%

A Study of the Volume of the Blood in Congestive Heart Failure. Relation to Other Measurements in Fifteen Patients

Meneely

Kaltreider²

1943

J. Clin. Invest.

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While the volume of the blood in health is quite constant and closely related to the size, age, and sex of the individual, it has long been recognized that in congestive heart failure, this relationship is disturbed. Therefore, investigations of the volume of the blood in this clinical condition should throw light on the mechanism of normal control of the volume of the blood as well as on the nature of the physiological disturbances involved in heart failure itself. Studies of this nature, summarized by Gibson and Evans (1), indicate that there is an increase in the volume of the blood in this condition. While this generality is well supported, there is a striking variability in individual cases. It appeared likely that this variability might be accounted for if quantitative measurement of factors which might influence blood volume were made at the time of the determination of the blood volume. Since the association between anoxemia and compensatory polycythemia is well established, measurements of arterial and venous oxygen were made and it proved possible to show a rough quantitative relationship between anoxemia and cellular increase. On the other hand, while the statement has been made (1, 2) that there is a positive relationship between the venous pressure and the change in blood volume in congestive heart failure, it was not possible to find such a relationship within this group of severely congested cardiac patients.Although a number of the lines of investigation pursued did not lead to the establishment of any simple correlation with plasma or cell volume changes, these data presented are of interest, not only in themselves, but also because certain interesting relations obtain between them. The results of these studies conducted on cardiac patients are therefore presented in full.1 Louisiana State University School of Medicine, New Orleans, La. MATERIALFifteen patients were selected who had clinical evidence of severe congestive heart failure (class IV). All were dyspneic or orthopneic, all but one had pitting edema, all but one had hepatomegaly, most had chronic passive congestion of the lungs, a few had hydrothorax, several had ascites. The clinical findings in these patients are summarized in Table I. Every effort was made to select uncomplicated cases, who were untreated, or who were in a steady state despite digitalis. Etiology of the heart disease in these cases included rheumatic heart disease, arteriosclerosis, hypertension, thyrotoxicosis, syphilis, and heart disease secondary to pulmonary disease. The duration of failure ranged from a few weeks to several years. Patient number seven had evidence of a moderate degree of renal insufficiency and he also had hemoptysis. None of the others had evidence of chronic blood loss. Five patients were female and ten were male. The average age was 542 years, with one subject in the third decade, five in the fourth decade, four in the fifth, and five in the sixth decades. METHODSThe patient was brought to the laboratory in bed in the post-absorptive state. T...

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Section: Discussionmentioning

confidence: 99%