Abstract
The diuretic action of bismuth has now been demonstrated in a total of 21 patients with edema, thus confirming the results previously reported. 1 Attempts are being made to determine, if possible, the mechanism of the diuretic action from comparisons with the well-known diuretics, digitalis and theophylline, and chemical analyses of blood and urine. The results on 10 patients with edema are definite enough to warrant a report at this time.
The edemas represented were mostly anasarca of cardiac origin, nephrosis, and ascites due to hepatic cirrhosis. The patients were at complete rest in bed on constant fluid and salt intakes throughout. Urine was collected during 24-hour periods and samples of blood were removed daily, or as often as necessary, for analysis. Urea of the blood and urine was estimated by Folin's method 2 ; chlorides of the blood by Austin and Van Slyke's method 3 ; chloride of the urine by the Seelman-Volhard method, 4 and hemoglobin by Palmer's method. 5 After suitable control periods, at least 2 and sometimes all 3 of the following drugs were administered successively with intervening periods without medication; bismuth sodium tartrate (Searle), 0.03 to 0.06 gm. intramuscularly; powdered (standardized) digitalis in capsules, 0.4 to 2.5 gm. orally; and theophylline sodium acetate, 1.2 gm. orally, total doses. Generally, the bismuth was used after the other diuretics had been tried.
Briefly summarized, the results obtained in 8 patients showing definite diuretic action were as follows: The maximum increase in daily urine output after digitalis was from 100% to 190% of the control output; after theophylline, from 30% to 280%; and after bismuth from 10% to 360%. The duration of the diuresis after digitalis was about 4 days, after theophylline 1 day, and after bismuth 4 days (medians).
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