SALT CONSUMPTION — KAUNITZ 451 



hormones on carbohydrate metabolism are perhaps interrelated and 

 that the mechanism of this effect is the stimulation of the cortex by salt. 

 The restoration of carbohydrate metabolism in adrenalectomized ani- 

 mals may perhaps be due to the stimulation by salt of tissues which are 

 functionally related to the adrenals. Additional material in support 

 of such a theory will be given below. 



Thus, the conclusion is unavoidable that cortical hormones and salt 

 enhance each other's actions. But the question must be asked whether 

 this relationship is important when salt is added to the diet, because 

 one might argue that excess salt leads to a compensatory decrease in 

 adrenal secretion of some of the hormones. This latter seems im- 

 probable because it has been shown experimentally that increased salt 

 intake is followed by adrenal enlargement suggestive of adrenal 

 hyperfunction. Clinically, high salt intake is probably related to 

 hypertension, again a sign of high cortical hormone secretion. 



Such a concept is supported by the effect of sodium chloride in a 

 number of conditions which have in common : loss of sodium chloride 

 by way of one of the body fluids, a drop in serum sodium chloride, 

 and a favorable response to the administration of salt. In addition 

 to Addison's disease, one should mention here heat exhaustion, various 

 uremic conditions with or without histological signs of kidney disease, 

 and high intestinal obstruction. It is usually believed that the benefit 

 resulting from the intake of sodium chloride in these conditions is 

 due to the replacement of sodium chloride which has been lost. A 

 more careful analysis indicates a different mechanism. 



In profuse sweating, the sodium content of the sweat and urine 

 is rapidly reduced to such an extent that the total salt loss was, within 

 5 to 8 hours, less than that occurring in the same period without pro- 

 fuse sweating; a correlation between the salt content of sweat and 

 adrenal activity has been fairly well established. The fact that vari- 

 ous uremic conditions respond favorably to salt administration has 

 been well known for at least 30 years. These studies are related to 

 observations on "salt wasting nephritis." No balance studies indi- 

 cate whether these patients actually had a negative salt balance. We 

 were able to carry out such a study on one patient with a rapidly 

 progressing uremia, profuse vomiting, and a drop in serum sodium 

 chloride. This patient consumed only a little bread and milk and 

 yet had a positive sodium and chloride balance. Similarly, it is 

 known that the amounts of sodium chloride necessary for improving 

 the condition of animals vomiting because of intestinal obstruction are 

 much higher than the amounts actually lost. 



The improvement produced by salt in the above conditions cannot 

 be due merely to the replacement of salt losses but must be rooted 

 partly in some pharmacological effect of the substance. The thera- 



