Water and Electrolytes in Congestive Failure 293 



During the whole course, the serum sodium level did not 

 change significantly. Laragh and Stoerk (1957) concluded 

 from these results that the higher serum potassium level is 

 probably a stimulus for the secretion of aldosterone. 



If patients with heart failure respond to a low sodium and 

 high potassium intake in the same way as normal subjects, 

 our customary therapeutic procedure would assist in the 

 creation of secondary aldosteronism. 



Reduction of body water increases the excretion of aldo- 

 sterone in normal subjects (Luetscher, Deming and Johnson, 

 1951, 1952; Beck et al, 1955; Falbriard et al, 1955; Bartter 

 et al., 1956; Garrod, Simpson and Tait, 1956). When the 

 volume of extracellular fluid rises, the urinary elimination of 

 aldosterone diminishes (Beck et al., 1955; Liddle et ah, 1955; 

 Muller, Riondel and Mach, 1956). 



In patients with congestive failure and other oedematous 

 states there is on the contrary an expanded extracellular fluid 

 volume associated with a rise in the urinary excretion of 

 aldosterone. The explanation of this reversed reaction is at 

 present difficult. Wolff, Koczorek and Buchborn (1957) 

 argue that in congestive failure there must be a disturbance of, 

 or anew regulatory mechanism for the secretion of aldosterone. 



Increased elimination of aldosterone in the urine was 

 found in the first week following surgical intervention 

 (Llaurado, 1955; WolfP, Koczorek and Buchborn, 1957) or 

 acute myocardial infarction without signs of congestive 

 failure (Wolff, Koczorek and Buchborn, 1957). This may be 

 explained by a diminution of extracellular fluid volume. 

 But one must not neglect the fact that in all such stressful 

 situations there is a raised adrenergic activity; and the same 

 stimulus may perhaps also lead to an increased production of 

 aldosterone, irrespective of the level of extracellular fluid 

 volume, as seems to be the case in congestive failure. 



Summary 



Retention of salt and water in heart failure is caused by 

 disturbed renal function. The main factors are a decreased 



