The Use of Chlorothiazide in the Treatment of Edema: A Comparison With Other Diuretic Agents

Abstract

The ideal diuretic should have the following six properties: (1) it should be effective by mouth; ( 2 ) it should be at least as potent as other diuretics currently available; ( 3 ) it should induce a diuresis of water, sodium, and chloride in such proportions that their relationship in the extracellular fluid remains unaltered; (4) it should not cause any electrolyte imbalance; ( 5 ) it should act rapidly, enabling patients to respond initially without becoming refractory later and, if necessary, continuous administration should allow the seriously incapacitated patient to have a diet containing a palatable amount of sodium chloride; and (6) it must be devoid of toxic effects.Such a substance does not yet exist, but chlorothiazide meets many of its desiderata. This paper presents an account of how far it achieves this intent and how far it falls short of it. Elsewhere we have described our clinical experience with this compound as a diuretic agent in patients afflicted with edema due to a variety of causes.' Ejectiveness by MouthAfter an oral dose of 1 gm., the eucretion of sodium and water increases during the second hour, and usually reaches a maximum between the sixth and eighth hours (FI(:URE 1). The total duration of the diuresis varies, but usually lasts 10 to 14 hours.Chlorothiazide is effective by mouth.

The action of chlorothiazide in the perfused cat kidney

“…The first point of interest arising out of these experiments is the very great similarity of the effect of chlorothiazide in man (Laragh 1958;Bayliss et al 1958) and in intact animals (Beyer, 1958) on the excretion of sodium, potassium and water, and the effect of this drug on isolated cat kidneys perfused with blood drawn from intact animals (Fig. 1).…”