Unrecognized Hyponatremia and Hypochloremia

D IR. GRIFFITH: "To reduce edema, to decrease, ilnsofar as possible, the sodium content of the body": From the time the role of sodium in the retention of fluid was first established, this has been a cardinal prescription in the management of congestive heart failure and other conditions in which there is an extracellular accumulation of fluid. This precept is rooted inl the belief that fluid in the peripheral tissues superimposes an added burden upon an already handicapped heart and should, therefore, be removed as speedily as possible, by whatever meais or combination of means are at hand. The mistaken belief that congestive failure can exist only in the presence of excessive sodium retention, coupled with the coniviction that salt restriction is not in itself harmful, has led to abuses of a regimenll that, judiciously employed, is invaluable in the treatment of heart failure. Years ago, before we learned to remove salt from the diet efficiently, before the time of powerful mercurial diuretics, and before the development of ion-exchange resins, hyponatremia and hypochloremia were observed on but few occasions. The methods then in use were too crude to reduce levels of sodium and chlorides in the body to a dangerous level. But today our tools are more precise, and constant safeguards are necessary. Inl each of the cases to be presenlted, the patienlt was from the first under the care of