294 Z. Fejfar 



renal blood flow and an increased tubular reabsorption of salt 

 and water. High venous pressure in the systemic circulation 

 is not the primary cause of this disturbed water balance. 

 It may, however, contribute to it. 



In congestive failure there is not merely a simple retention 

 of extracellular electrolytes and water. Serious metabolic 

 changes may also occur. Great clinical significance should be 

 attached to cellular potassium depletion. The laboratory 

 diagnosis of the latter is difficult, the best method at present 

 being chemical analysis of muscle biopsy specimens. One must 

 consider this disturbance in every patient with heart failure, 

 and consequently treat all such patients with sufficient 

 potassium in the diet, or by administering potassium salts, 

 particularly when mercurial diuretics are used. 



Consideration was given to the significance of regulatory 

 mechanisms responsible for renal dysfunction in congestive 

 failure. The primary role of reflex changes was stressed and 

 the present knowledge of the role of aldosterone and ADH 

 was discussed. 



Acknowledgements 



I should like to thank Drs. J. H. Cort and A. Hlavova and Miss D. 

 Rosicka for carrying out the muscle biopsy analyses. 



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