Effect of Sodium Chloride in Treatment of a Patient with Addison's Disease

Abstract

It has been shown recently that the sodium content of the blood of patients suffering from Addison's disease is decreased 1 as it is in adrenalectomized cats,^{2, 3} and that adrenalectomy in dogs results in a similar change, due to loss of sodium through the kidneys. 4 Soddu found that the symptoms of adrenal insufficiency in dogs “were relieved slightly by saline injections” 5 and many investigators, notably Marine and Baumann, 2 have shown that injections of salt solution prolong appreciably the life of adrenalectomized cats. Rogoff 6 has stated that “the intravenous administration of physiologic solutions of sodium chloride” becomes an “indispensable adjuvant in the treatment of Addison's disease with extracts representing the hormone of the adrenal cortex.” This investigator attributes the action of NaCl solutions to the relief of “toxic accumulation” for which no evidence has been presented other than the accumulation of urea in the blood. In view of these facts, the responses of a patient with Addison's disease to the feeding and withdrawal of sodium chloride have been followed over a period of 6 months. This patient (P.H. 347860) presented the classical picture, complaining of progressive weakness, loss of appetite and weight and increasing pigmentation of the skin, nipples and buccal mucous membranes. Her blood pressure when first seen was 90/60. X-rays of the chest and abdomen were negative. There was a mild secondary anemia. Urine and stool examinations were negative.

The results of the various studies of the blood are shown in Table I. During the first week following admission, the patient's condition grew progressively worse, until the seventh day, when she became critically ill and her blood pressure fell to 65/48. Her complaints were profound exhaustion, slight dyspnoea and increasing nausea and recurrent vomiting.