'Day Wetting in Boys

surgery being advised in all cases. In the patients with secondary hyperaldosteronism spironolactone produced -little or no change in blood pressure. This finding accords with earlier reports8" showing that some patients with essential hypertension may have a small fall in blood pressure when treated with either spironolactone or a benzothiadiazine or related diuretic. Thus it would seem that primary aldosteronism causing hypertension should be treated by surgery, or, when indicated, by glucocorticoid suppressions The secondary aldosteronism found in malignant hypertension mayl disappear when the blood pressure is effectively controlled.1' But there is a place for spironolactone in the management of ciedema. While the drug by itself is relatively ineffective, it may be useful in combination with another diuretic." Used in this way it antagonizes the effect of the increased secretion of aldosterone that results from the sodium depletion and shrinkage of plasma volume induced by the primary diuretic, and it thereby inhibits the distal tubular reabsorption of the sodium whose proximal tubular reabsorption is blocked by the primary diuretic. In this way spironolactone may increase output of sodium and reduce output of potassium. Nevertheless, it may still be necessary on occasion to administer potassium supplements to prevent hypokalaemia. But this last addition to the diuretic regimen must be cautiously made when any renal failure is present, for in this situation even spironolactone alone may give rise to dangerous hyperkalaemia."3 Care must also be taken in the administration of potent diuretics to patients with severe cirrhosis and ascites lest they precipitate death from hyponatraemia and azotaemia.14