1950) were applied to our first patients
- Harken, Baker
- (Bedford, et al.,
however. In the initial stages of treatment it is essential to estimate the blood electrolytes, particularly chloride and potassium, at least weekly. There is a tendency to hyperchloraemia, so ammonium chloride should not be used as an adjuvant to mercurial diuretics while resins are being given. Special care is necessary when there is any evidence of renal damage. Treatment should always be started in hospital but can be maintained after discharge. In some of our cases we have noticed that although mercurial diuretics produced little response before resin treatment, a good diuresis followed subsequent injections. Some patients who improve very little with resin treatment alone may improve when this is combined with a low sodium diet. The best combination of sodium intake, mercurial diuretics and resin treatment still seems to be a matter of trial and error in refractory cases of heart failure and it must be admitted that although the cation exchange resins are a valuable new weapon in the control of sodium metabolism in heart failure our use of them is still rather tentative and exploratory.