A HIGH FLUID INTAKE IN THE MANAGEMENT OF EDEMA, ESPECIALLY CARDIAC EDEMA

F.R. Schemm

Annals of Internal Medicine · 1942 · 72 citations · 47 references

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Abstract

Article1 December 1942A HIGH FLUID INTAKE IN THE MANAGEMENT OF EDEMA, ESPECIALLY CARDIAC EDEMAI. THE DETAILS AND BASIS OF THE RÉGIME*F. R. SCHEMM, M.D., F.A.C.P.F. R. SCHEMM, M.D., F.A.C.P.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-17-6-952 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptThis paper presents the details of a régime which, in the past eight years, has been used in approximately 600 separate periods of treatment carried out on a series of about 400 cases of advanced disease, 96 per cent of which were cases of cardiovascular-renal disease. In this series there were about 375 cases, or 94 per cent, with gross heart disease, of which over 200 showed gross edema.Only a few of the reasons which led to a trial of this régime can be mentioned here. There are clinical observations77 to 93from Withering through Austin Flint to recent...References WATER-BALANCE AND RENAL-FUNCTION BODY FLUID EDEMA FORMATION DIURETICS AND DEHYDRATION BASIC SIMILARITIES IN EDEMA-PRODUCING DISEASE CLINICAL OBSERVATIONS, OLD AND NEW1. NEWBURGHJOHNSTONFALCON-LESSES LHMWM: Measurement of total water exchange, Jr. Clin. Invest., 1930, viii, 161-196. CrossrefGoogle Scholar2. LASHMETNEWBURGH FHLH: Specific gravity of urine as test of kidney function, Jr. Am. Med. Assoc., 1930, xciv, 1883-1885. CrossrefGoogle Scholar3. LASHMET FH: The treatment of nephritic edema by acid, Jr. Am. Med. Assoc., 1931, xcvii, 918-919. CrossrefGoogle Scholar4. WILEYNEWBURGH FHLH: An improved method for determination of water-balance, Jr. Clin. Invest., 1931, x, 723-731. CrossrefGoogle Scholar5. NEWBURGHLASHMET LHFH: A comparative study of the excretion of water and solids by normal and abnormal kidneys, Jr. Clin. Invest., 1932, xi, 1003-1009. Google Scholar6. NEWBURGHLASHMET LHFH: The importance of dealing quantitatively with water in the study of disease, Am. Jr. Med. Sci., 1933, clxxxvi, 461-470. Google Scholar7. FREYBERGLASHMET RHFH: A quantitative study of renal injury in a case of acute poisoning by bichloride of mercury with a note regarding treatment, Am. Jr. Med. Sci., 1935, clxxxix, 392-399. CrossrefGoogle Scholar8. NEWBURGHMACKINNON LHF: The practice of dietetics, 1934, Macmillan, New York, pp. 7-20, 86-97, 225-244, 253-258. Google Scholar8a. NEWBURGHJOHNSTON LHMW: The insensible loss of water, Physiol. Rev., 1942, xxii, 1-18. CrossrefGoogle Scholar9. ADDIS T: The osmotic work of the kidneys and the treatment of glomerular nephritis, Trans. Assoc. Am. Phys., 1940, lv, 223-229. Google Scholar10. COLLERMADDOCK FAWG: Dehydration attendant on surgical operations, Jr. Am. Med. Assoc., 1932, xcix, 875-880. CrossrefGoogle Scholar11. COLLERMADDOCK FAWG: A study of dehydration in humans, Ann. Surg., 1935, cii, 947-960. CrossrefGoogle Scholar12. COLLERDICKMADDOCK FAVSWG: Maintenance of normal water exchange with intravenous fluids, Jr. Am. Med. Assoc., 1936, cvii, 1522-1527. CrossrefGoogle Scholar13. MADDOCKCOLLER WGFA: Water-balance in surgery, Jr. Am. Med. Assoc., 1937, cviii, 1-6. Google Scholar14. WASSELL GK: Increased vaporization of water by the post-operative patient in summer, Univ. Hosp. Bull., Ann Arbor, 1938, iv, 26-28. Google Scholar15. CHESLEY LC: Renal excretion at low urine volumes and the mechanism of oliguria, Jr. Clin. Invest., 1938, xvii, 591-597. CrossrefGoogle Scholar16. ROWNTREE LG: The effects of experimental passive congestion on renal function, Arch. Int. Med., 1913, xi, 120-147. CrossrefGoogle Scholar17. COLLER FA: The replacement of sodium chloride in surgical patients, Ann. Surg., 1938, cviii, 769-782. Google Scholar18. COLLERMADDOCK FAWG: Water and electrolyte balance, Surg., Gynec. and Obst., 1940, lxx, 340-354. Google Scholar19. MADDOCKCOLLER WGFA: Sodium chloride metabolism of surgical patients, Ann. Surg., 1940, cxii, 520-529. CrossrefGoogle Scholar20. LENDON NC: Observations on effects of sustained muscular effort in hot climates with especial reference to loss of fluids and electrolytes, Jr. Royal Army Med. Corps, 1938, lxxi, 318-324. Google Scholar21. NADALPEDERSENMADDOCK SWSWG: Two contrasting types of dehydration, Univ. Hosp. Bull., Ann Arbor, 1941, vii, 53-55. Google Scholar22. STARLING EH: The fluids of the body, 1900, W. T. Keener & Co., Chicago, pp. 152-154, pp. 163-164, pp. 175-177. Google Scholar23. DARROWYANNET DCH: The changes in the distribution of body water accompanying increase and decrease in extracellular electrolyte, Jr. Clin. Invest., 1935, xiv, 266-275. CrossrefGoogle Scholar24. HASTINGSEICHELBERGER ABL: Exchange of water and salt between muscle and blood, Jr. Biol. Chem., 1937, cxvii, 73-93. Ibid: 1937, cxviii, 197-218. CrossrefGoogle Scholar25. EICHELBERGER L: The distribution of body water in skeletal muscle in dogs with impaired renal function, Jr. Biol. Chem., 1939, cxxviii, 137-152. CrossrefGoogle Scholar26. GAMBLE JL: Extracellular fluid, Bull. Johns Hopkins Hosp., 1937, lxi, 151-197. Google Scholar27. MILBERT AH: Infusion reactions with special reference to "speed shock," Am. Jr. Surg., 1934, xxvi, 479-485. CrossrefGoogle Scholar28. WARTHEN HJ: Massive intravenous injections, Arch. Surg., 1935, xxx, 199-227. CrossrefGoogle Scholar29. CUTTING RA: Distribution and excretion of water and chlorides after massive saline infusion, Arch. Surg., 1938, xxxvi, 586-613. CrossrefGoogle Scholar30. CUTTING RA: Cause of death resulting from massive infusions of isotonic solutions, Arch. Surg., 1939, xxxviii, 599-616. CrossrefGoogle Scholar31. GILLIGANALTSCHULELINENTHAL DRMAJ: Effects on cardiovascular system of man of fluids administered intravenously; studies of glomerular filtration rate as measured by urea clearance, Arch. Int. Med., 1939, lxiv, 505-512. CrossrefGoogle Scholar32. SMYTH FS: Studies in so-called water intoxication, Jr. Clin. Invest., 1930, xii, 55-65. Google Scholar33. COPE CL: Alkali poisoning, (Abst.) Jr. Am. Med. Assoc., 1937, cviii, 336. Google Scholar34. PETERS JP: Body water, 1935, C. C. Thomas Co., Baltimore. Google Scholar35. CANNON WB: The wisdom of the body, 1932, Norton, New York, pp. 27-28, 77-97, 168-176. Google Scholar36. BALDWIN E: An introduction to comparative bio-chemistry, 1937, Cambridge Univ. Press, London, pp. 34-42. Google Scholar37. BESTTAYLOR CHNB: The physiological basis of medical practice, 1937, Wm. Wood, Baltimore. Google Scholar38. LANDIS EM: The mechanism of edema formation, Mod. Concepts of Cardiovasc. Dis., 1935, iv, no. 11. Google Scholar39. LANDIS EM: Vascular physiology and clinical medicine, ANN. INT. MED., 1936, x, 290-298. Google Scholar40. PETERS JP: Total acid base equilibrium of plasma in health and disease. X. Acidosis of nephritis, Jr. Clin. Invest., 1929, vi, 517. CrossrefGoogle Scholar41. MOOREVAN SLYKE NSDD: Relationship between plasma specific gravity, plasma protein, and edema in nephritis, Jr. Clin. Invest., 1930, viii, 337. CrossrefGoogle Scholar42. MOORESTEWART NSHJ: Variation of specific gravity of plasma of blood and the means available for altering it, Jr. Clin. Invest., 1930, ix, 423. CrossrefGoogle Scholar43. STEWART HJ: Action of digitalis in uncompensated heart disease, Arch. Int. Med., 1938, lxii, 569-592. CrossrefGoogle Scholar44. STEWART HJ: The cardiac output in congestive heart failure and in organic heart disease, ANN. INT. MED., 1940, xiii, 2323. Google Scholar45. CALVINDECHERDHERMANN DBGG: Response of plasma volume to diuretics, Proc. Soc. Exper. Biol. and Med., 1940, xliv, 529-531. CrossrefGoogle Scholar46. WHIPPLE GH: Protein production and exchange in the body, including hemoglobin, plasma protein and cell protein, Am. Jr. Med. Sci., 1938, cxcvi, 609-621. CrossrefGoogle Scholar47. PRITCHARDSEYMOURLONGLEY WHWBLP: Changes in cardiac output, fluid volume and kidney function on recovery from congestive heart failure, Jr. Clin. Invest., 1941, xx, 4. Google Scholar48. STEWARD HJ: Mechanism of diuresis; alterations in specific gravity of blood plasma with onset of diuresis in heart failure, Jr. Clin. Invest., 1941, xx, 1-6. CrossrefGoogle Scholar49. LANDIS EM: Micro-injection studies of capillary permeability: III. The effect of lack of oxygen on the permeability of the capillary wall to fluid and to plasma proteins, Am. Jr. Physiol., 1928, lxxxiii, 528. CrossrefGoogle Scholar50. TOTH LA: Urine excretion during anoxia from normal and denervated kidneys in dogs with and without adrenal glands, Am. Jr. Physiol., 1940, cxxix, 532-538. CrossrefGoogle Scholar51. CUSICKBENSONBOOTHBY PLOOW: Effect of anoxia and high concentration of oxygen on the retinal vessels, Proc. Staff. Meet. Mayo Clin., 1940, xv, 500. Google Scholar52. ALTSCHULEBLUMGART MDHL: The circulatory dynamics in tricuspid stenosis, Am. Heart Jr., 1937, xiii, 589-598. CrossrefGoogle Scholar53. SNELL AM: Some comments of Osler's on cirrhosis, Am. Jr. Digest. Dis., 1938, iv, 762. Google Scholar54. ALTSCHULE MD: Clinical significance of physiological studies in cardiac decompensation in man, Mod. Concepts of Cardiovasc. Dis., 1940, ix, no. 11. Google Scholar55. POLLSTERN DJE: Untoward effects of diuresis (with special reference to mercurial diuretics), Arch. Int. Med., 1936, lviii, 1087-1094. CrossrefGoogle Scholar56. CANTAROW A: Water-balance; edema and dehydration, Internat. Clin. (N. S. 2), 1939, i, 266-300. Google Scholar57. KLINGHOFFER KA: Dehydration from diuretics, Internat. Clin. (N. S. 4), 1941, i, 221-226. Google Scholar58. TYSON MC: Danger of intravenous mercurial injections in nephrosis, Jr. Am. Med. Assoc., 1941, cxvii, 998-999. CrossrefGoogle Scholar59. DICKWARWEGANDERSCH MWEM: Acacia in the treatment of nephrosis, Jr. Am. Med. Assoc., 1935, cv, 654-657. CrossrefGoogle Scholar60. LANDIS EM: Observations on acacia therapy in nephrosis, Jr. Am. Med. Assoc., 1937, cix, 2031-2034. Google Scholar61. WILSONSUNDERMAN DMFW: Studies in serum electrolytes; XII. The effect of water restriction in a patient with Addison's disease receiving sodium chloride, Jr. Clin. Invest., 1939, xviii, 35. CrossrefGoogle Scholar62. ANDERSONBETHEA WAWR: Renal lesions following the administration of hypertonic solutions of sucrose, Jr. Am. Med. Assoc., 1940, cxiv, 1938. Google Scholar63. MURPHYCORRELLGRILL FDHJC: The effects of intravenous glucose on patients with and without cardiovascular defects, Jr. Am. Med. Assoc., 1941, cxvi, 104-108. CrossrefGoogle Scholar64. JEGHERSBAKST HHJ: The syndrome of extra-renal azotemia, ANN. INT. MED., 1938, xii, 1861-1899. Google Scholar65. ALLOT EN: Sodium and chlorine retention without renal disease, Lancet, 1939, i, 1035-1037. CrossrefGoogle Scholar66. LAYNEMOIR JAWW: Extra-renal uremia, Internat. Clin., (N. S. 4), 1941, iv, 183-203. Google Scholar67. DAVIS HA: Pathology of dehydration shock, Arch. Surg., 1941, xlii, 939-955. CrossrefGoogle Scholar68. CHRISTIAN HA: A clinical lecture as of twenty-five years ago, Am. Jr. Med. Sci., 1937, cxciv, 749-756. CrossrefGoogle Scholar69. RUBINRAPOPORT MIM: Cardiac complications of hemorrhagic nephritis, Am. Jr. Dis. Child., 1938, lv, 244-272. Google Scholar70. WINTERNITZMYLONWATERSKATZENSTEIN MCELLR: Relation of kidney to cardiovascular disease, Yale Jr. Biol. and Med., 1940, xii, 623-679. Google Scholar71. BLOOMFIELD AL: The natural history of chronic hepatitis (cirrhosis of the liver), Am. Jr. Med. Sci., 1938, cxcv, 429-444. CrossrefGoogle Scholar72. SIEGALALLEN SAC: Intercapillary glomerulosclerosis (Kimmelstiel-Wilson) and nephrotic syndrome in diabetes mellitus, Am. Jr. Med. Sci., 1941, cci, 516-528. CrossrefGoogle Scholar73. ZIMMERMANPETERS HMJP: Pathology of the pregnancy toxemias, Jr. Clin. Invest., 1937, xvi, 397-420. CrossrefGoogle Scholar74. DESNOO K: The prevention of eclampsia, Am. Jr. Obst. and Gynec., 1937, xxxiv, 911-939. CrossrefGoogle Scholar75. MCPHAIL FL: The toxemias of pregnancy, Jr. Am. Med. Assoc., 1938, cxi, 1894-1897. CrossrefGoogle Scholar76. MCPHAIL FL: Water exchange in toxemias, West. Jr. Surg., Obst. and Gynec., 1939, xlvii, 306-317. Google Scholar77. FLOYERBAYNARD JE: History of cold bathing both ancient and modern, II, (5th ed.), 1722, London; in JOHN BELL'S "On baths and the watery regimen," 1850, Barrington and Haswell, Philadelphia, pp. 204, 209 and 281. Google Scholar78. WITHERING W: An account of the foxglove . . . with practical remarks on dropsy, 1785, Robinson, Birmingham; in RODDIS, H. L.: The introduction of digitalis into medical practice, 1936, Paul B. Hoeber, New York, p. 72. Google Scholar79. DARWELL J: Dropsy, in JOHN FORBES' "Cyclopedia of practical medicine," 1845, Lea and Blanchard, Philadelphia, p. 720. Google Scholar80. NAPHEYS GH: Modern medical therapeutics; a compendium of recent formulae and specific therapeutical directions, from the practice of eminent contemporary physicians, American and foreign, (5th ed.), 1878, Brinton, Philadelphia, pp. 383-395; 417-418. Google Scholar81. FLINT A: Clinical medicine, 1879, H. C. Lea, Philadelphia, p. 47. Google Scholar82. FLINT A: A treatise on the principles and practices of medicine (6th ed.), 1886, Lea Bros. and Co., pp. 32-33, 64; 72-85, 866, 872-873, 895. Google Scholar83. OSLER W: Principles and practice of medicine, (2nd ed.) 1896, D. Appleton, New York, p. 787. Ibid., 1923 (9th ed.), p. 695. Google Scholar84. FARR LE: Conference on therapy; treatment of edema, Jr. Am. Med. Assoc., 1939, cxii, 837-843. Google Scholar85. STROUDVANDERVEER WDJB: Symposium on salt and water balance and acid-base equilibrium; problem of water-balance in congestive heart failure, Pennsylvania Med. Jr., 1940, xliii, 1116-1120. Google Scholar86. BINGER MW: General treatment of edema, Proc. Staff Meet. Mayo Clin., 1936, xi, 648-650. Google Scholar87. BINGER MW: Edema (editorial), ANN. INT. MED., 1941, xv, 617. LinkGoogle Scholar88. WILLIUS FA: Regulation of diet in heart disease, Proc. Staff Meet. Mayo Clin., 1936, xi, 202-206. Google Scholar89. CHRISTIAN HA: In OSLER'S Principles and practice of medicine, 1938, D. Appleton Century Co., New York, p. 1036. Google Scholar90. LEVINE SA: Clinical heart disease, 1936, W. B. Saunders, Philadelphia, pp. 301-302. Google Scholar91. LEVINE SA: The management of heart failure, Jr. Am. Med. Assoc., 1940, cxv, 1715-1719. CrossrefGoogle Scholar92. SCHROEDER HA: Personal communication, 1939. Google Scholar93. SCHROEDER HA: Studies on congestive heart failure. I. The importance of the restriction of salt as compared to water, Am. Heart Jr., 1941, xxii, 141-153. CrossrefGoogle Scholar94. SCHROEDERFUTCHER HAPH: Studies on congestive heart failure. II. Impaired excretion of sodium chloride, Am. Jr. Med. Sci., 1942, cciv, 52-62. Google Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAuthors: F. R. SCHEMM, M.D., F.A.C.P.Affiliations: Great Falls, Montana*Read at the St. Paul meeting of the American College of Physicians April 22, 1942.From the Medical Department of the Great Falls Clinic, Great Falls, Montana.†From 1930 to 1933 while instructor in internal medicine in Ann Arbor where Newburgh's renal-function and water-balance work was being applied clinically to nephritis and being applied to surgical problems by Coller and Maddock.1, 2, 3, 4, 5, 6, 7, 8, 10 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byDIURETICS AND DIURESISDie Verteilung von Natrium und ChloridKaliumverteilungTreatment of the Patient With Refractory Heart FailurePRESENT CONCEPTS OF THE MECHANISM OF URINE FORMATION AND OF DIURETIC ACTION*Water and Electrolyte Metabolism in Congestive Heart FailureOsmolarity Disorders of the Body FluidsPathophysiologie der HerzinsuffizienzTherapie der HerzinsuffizienzManaging Unmanageable EdemaThe management of congestive heart failure with a free salt intakeThe alkali metal ions in the organismThe pathogenesis and treatment of hyponatremia in congestive heart failureApplication of Homeostatic Principles to the Management of Nephrotic PatientsControl of body fluid volumeCorticotropin (ACTH) in Heart Disease: Its Paradoxical Effect on Sodium Excretion in Resistant Congestive FailureErnährungstherapieErnährungstherapieINTAKE AND OUTPUT OF WATER IN THE CONTROL OF BODY WATER CONTENTDie Krankheiten der Leber und der GallenwegeObservations of Patients on Low-Sodium Diets1Electrolyte and Fluid Disturbances in Congestive Heart FailureWater and Electrolyte Balance in DiseaseTypes and Treatment of Nephritis in ChildrenThe Importance of Diet as a Therapeutic Measure in Cardiovascular Renal DiseaseSalt-Depletion Syndrome as a Complication in the Treatment of Cardiorenal DiseaseA consideration of the mechanism of congestive heart failureToleration of a high water intake by patients with high-grade mitral stenosis in the last trimester of pregnancyX A Concept of Allergy as Autonomic Dysfunction Suggested as an Improved Working HypothesisFurther Comparative Studies on Ascites in Liver and Heart DiseaseVALUE OF ELECTROMYOGRAPHY IN CLINICAL NEUROLOGYCARDIAC FAILUREStudies on Congestive Circulatory FailurePathogenesis and Treatment of Salt and Water Retention in Congestive FailureWater Balance in Heart and Kidney Disease as Related to Edema and OliguriaGREAT REDUCTION IN HEART SIZE ATTENDING THE CLEARING OF CONGESTIVE HEART FAILURE IN A MAN WITH HYPERTENSIVE AND CORONARY HEART DISEASE*JAMES H. CURRENS, M.D., PAUL D. WHITE, M.D., F.A.C.P.Advances in the Treatment of Heart DiseaseNeurohormanal bedingte Herzkrankheiten (Pathogenese und Therapie)Mechanisms of salt and water retention in heart failureCERTAIN CLINICAL ASPECTS OF THE APPLICATION OF WATER BALANCE PRINCIPLES TO HEART AND KIDNEY DISEASE*F. R. SCHEMM, M.D., F.A.C.P.Dietary Management in Heart Disease with Particular Reference to Congestive Cardiac FailureEXPERIENCE WITH THE SCHEMM REGIMEN IN THE TREATMENT OF CONGESTIVE HEART FAILURE*ABBOTT A. NEWMAN, M.D., HAROLD J. STEWART, M.D., F.A.C.P.RENAL DISEASES: SOME FACTS AND PROBLEMS*LOUIS LEITER, M.D., Ph.D.URINE VOLUME AND TOTAL RENAL SODIUM EXCRETION DURING WATER DIURESIS*ANDREW J. CRUTCHFIELD JR., J. EDWIN WOOD JR.A system for the routine treatment of the failing heartPathogenesis of peripheral cardiac edemaTHE RELATIVE IMPORTANCE OF DIETARY SODIUM CHLORIDE AND WATER INTAKE IN CARDIAC EDEMA*L. W. GORHAM, M.D., D. E. LESTER, M.D., A. V. WOLF, Ph.D., H. H. SHULTZ, M.D.The physiology of water in diseaseLow-Sodium Diet and Free Fluid Intake in the Treatment of Congestive Heart FailureWHAT CAN BE ACCOMPLISHED IN THE TREATMENT OF HEART DISEASES* HAROLD J. STEWART, M.D., F.A.C.P.Diet and Diuretics in the Treatment of Congestive Heart FailureThe Heart in Rheumatic FeverA HIGH FLUID INTAKE IN THE MANAGEMENT OF EDEMA, ESPECIALLY CARDIAC EDEMA. II. CLINICAL OBSERVATIONS AND DATA*F. R. SCHEMM, M.D., F.A.C.P.Care of the Patient with Chronic Heart DiseaseREACTIONS TO PARENTERAL FLUID ADMINISTRATION*MAX M. STRUMIA, M.D., JOHN J. MCGRAW, M.D., ALTON BLAKE, M.D. 1 December 1942Volume 17, Issue 6Page: 952-969KeywordsCardiovascular diseasesCardiovascular therapyEdemaFallsNephritisRenal diseases ePublished: 1 December 2008 Issue Published: 1 December 1942 PDF downloadLoading ...

References

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