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METABOLIC PROBLEMS ARISING IN THE MANAGEMENT OF CONGESTIVE HEART FAILURE

GRACE E. BERGNER, M.D.; JAMES H. HUTCHINSON, M.D.; JOHN W. KOEHLER, M.D.; EDWARD L. CZEBRINSKI, M.D.
AMA Arch Intern Med. 1951;88(3):387-394. doi:10.1001/archinte.1951.03810090118012.
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THREE patients who received conventional therapy for heart failure at the St. Louis City Hospital regained compensation but died within a few days without apparent cause. Anorexia, lethargy, and, eventually, stupor preceded the death of each. Analysis of their records and clinical course suggested that an electrolyte imbalance had been precipitated during the treatment of the cardiac failure. Later, when similar patients were treated in a comparable manner, acidosis was discovered and dramatically corrected by the judicious use of sodium lactate. This experience led us to study the blood chemical pattern in patients with congestive heart failure before and during treatment with digitalis, ammonium chloride, mercurial diuretics, and a low-salt diet.

METHOD OF STUDY  Twenty-four patients in severe congestive heart failure were studied during the winter months when environmental temperatures could be controlled. Most of these patients had hypertensive or arteriosclerotic heart disease, or both. An attempt was made to

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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