Observations on the action of novasural in heart disease.

Abstract

Novasural is a preparation containing 33.9 per cent of mercury bound in a large molecule. It is given as a 10 per cent solution in doses of 1 to 2 cc. It was originally introduced as an antisyphilitic, but its marked action on urine output suggested its use as a diuretic. It was first used for this purpose by Zeiler. 1 Later studies have been published by Saxl and Herlig, 2 Mühring 3 and Nonnenbruch. 4 These writers agree as to its efficiency as a diuretic in selected cases, but fail to agree on the mechanism of its action.

In our cases novasural has been administered to patients with severe heart failure and edema in whom digitalis had failed to relieve the edema. It has been administered in 1 to 2 cc. doses intramuscularly and has been followed by a striking diuresis—the output often rising from 300 cc. to 2000 to 3000 cc. per diem.

The diuresis as a rule starts within two hours and attains its maximum in three to nine hours. The more serious the case, the more delayed is the time of the maximum diuretic effect. The action passes off in about 24 hours.

Studies have been made of the urine, blood, and when possible the edema fluid before, during and after the diuresis. During the diuresis the total output of chlorides in the urine is increased and the concentration is also increased. The total urea and ammonia in the urine may be increased, but the concentration is reduced. The blood chlorides are slightly reduced and the chlorides in the edema fluid follow closely those of the blood. The blood urea shows practicallly no alteration.

There has been marked clinical improvement in all cases and no untoward effects have been observed.