Studies in Serum Electrolytes. Xii. the Effect of Water Restriction in a Patient with Addison's Disease Receiving Sodium Chloride.

The efficacy of sodium salts in the treatment of adrenal cortical insufficiency in man and experimental animals has been recognized, and the changes in the distribution and excretion of water and electrolytes following their therapeutic use have been investigated (1, 2, 3, 4). This present study is concerned with the effect of variations in the total water consumption of a patient with Addison's disease receiving a relatively constant high intake of sodium chloride. Observations in the literature concerning adrenal insufficiency suggest that the changes in the distribution of body water are secondary to changes in the distribution of sodium and potassium. The forced ingestion of water by mouth is apparently ineffective per se in preventing the development of hemoconcentration observed in insufficiency. If sufficient water be given an adrenalectomized dog receiving no cortical extract and on low intake of salt, a fairly constant fluid balance may be obtained and yet hemoconcentration may develop (5). Hemoconcentration and dehydration are commonly observed in severe crisis. The hemoconcentration is recognized by the increased concentration of hemoglobin, the increased percentage of erythrocytes, and the small proportion of serum yielded from blood. Studies in experimental insufficiency indicate that the blood volume is diminished (6) and that the amount of interstitial fluid may be reduced as well (7). The diuresis that frequently occurs with the onset of a crisis is apparently inadequate to account for the diminution in serum volume (8). Harrop suggests that the most important factor responsible for the observed hemoconcentration is a " movement of extracellular fluid 'into the tissue cells " (7). 1 Aided by a grant from the Faculty Research Committee, University of Pennsylvania, Philadelphia, Pennsylvania. Upon withdrawal of cortin from adrenalectomized dogs maintained on a sodium and chloride free diet, Swingle, Parkins, Taylor, and Hays (9) observed that hemoconcentration and circulatory collapse occurred without the loss of sodium, chloride, or water by way of the urine. Furthermore, the injection of massive doses of cortin alone brought about a dilution of the blood and a relief of symptoms. Although not entirely apparent from their data they concluded that the injection of cortical extract mobilized the accumulation of intracellular fluid and electrolytes, and shifted them from the intracellular to the extracellular and vascular compartments. In an effort to obtain further information upon the problems of hemoconcentration and the internal shift of water in adrenal insufficiency, this study of water and electrolyte metabolism iri Addison's disease was undertaken.