The use of calcium chloride in edema due to heart failure.

Abstract

This study concerns the reduction of edema in heart failure especially in those patients in whom the effort to increase the amount of diuresis by digitalis, theocin and diuretin fails. Blum 1 and his coworkers have made efforts in this direction, using calcium chloride as an agent and giving it by mouth. Singer, 2 basing his observations on Loewi's experiments, reported striking successes by giving calcium chloride and digitalis together intravenously. It may be recalled that Loewi 3 believes he has shown that calcium and digitalis have identical effects, the function of digitalis being merely to sensitize the heart muscle to the action of calcium. In one patient whom we have observed over a long period of time digitalis, theocin and diuretin produced a diuresis but not to the extent of freeing the patient of edema. She was, on the other hand, on repeated occasions made edema free by using calcium chloride. We did not make studies to determine the mechanism by which this diuresis was brought about. The results are summarized in Table I. Obviously calcium chloride produces diuresis both when given alone and when combined with digitalis. At times the diuresis continues from one to two days after calcium chloride has been discontinued. Of a total of 16 observations in which calcium chloride was given by mouth to five patients only once did it fail to produce some degree of diuresis. In two patients the diuresis resulting from the calcium chloride was effective in freeing them of edema,

but in the three remaining cases the diuresis was not sufficient to make any impression on the degree of the edema.

Before giving calcium chloride intravenously to patients we took the precaution of making preliminary observations on dogs with the view to learning the dose with which toxic effects on the heart are induced.