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MERCURIAL DIURETICS: THE ADDITION OF MAGNESIUM SULPHATE TO PREVENT THE TOXIC EFFECTS OF THEIR INTRAVENOUS ADMINISTRATION

1944; BMJ; Volume: 6; Issue: 4 Linguagem: Inglês

10.1136/hrt.6.4.197

1468-201X

Ignacy Pines, Antonio Sanabria, R. T. H. Arriens,

Poisoning and overdose treatments

The importance of mercurial diuretics in the treatment of heart failure has been obvious ever since the discovery of these useful drugs.Subsequent studies have explained to some extent the mechanism of their action.The relief afforded to the heart by the administration of mercurial diuretics in cardiac failure depends on the elimination of cedema, on the decrease of the volume of circulating blood, and sometimes on the fall of the arterial blood pressure..The interaction of these factors throws much less burden upon the exhausted heart.The disappearance of cedema is itself of great importance.This is accompanied, as has been shown by Blalock et al.l, by the decrease of the volume of blood flow needed by the tissues for their metabolic requirements, and a reduction of the mechanical resistance of the tissues to the flow of blood.The fall of blood pressure noted many times by various observers after the improvement of the circulation, which can perhaps be attributed to the diminution of local venous pressure in the kidney (Corrigan and Pines 2), acts also in the same direction.To these must sometimes be added an increase in the functional capacity of the heart muscle because of a decrease in the heart cedema itself, as well as the complicated effects of the relief of congestion of other important organs.So, for instance, the diuresis after mercurial diuretics has a very favourable influence upon cardiac dyspnoea and on the congestion of the lungs.Also the abdominal circulation is much improved because there is less engorgement of the liver.Finally, the disappearance of the discomfort to which the patient with heart failure is exposed, the recession of insomnia and of the cough, the improved absorption of certain nutritional factors and in particular of vitamins, the decrease of basal metabolism, all these and other factors make the improvement due to diuresis induced by mercurial diuretics even more striking.It is not surprising, therefore, that mercurial diuretics are highly rated amongst other drugs used in heart failure.According to Thomson,3 Marvin,4 and others their diuretic effects are often as great with digitalis as without it.Fishberg 5 points out that they not only " supplement the digitalis, but instances are not rare in which mercurials are decidedly more efficacious than digitalis" itself.Withering's discovery is considered generally to be the opening of the first chapter in the efficient treatment of heart failure.There cannot be the slightest doubt, then, that the introduction of mercurial diuretics by Saxl and Heilig6 has marked-the beginning of the second period.The diuretic properties of mercurials were known, of course, even before the papers of Viennese authors appeared.According to Goodman and Gilman,7 calomel was used by Paracelsus for this purpose in the sixteenth century.Later on, Jendrassik,8 in 1886, confirmed the beneficial action of this drug upon patients suffering from cardiac dropsy.Fourneau and