Heparin and the water metabolism with special reference to the ADH.

It was Raynaud and his co-workers") who in 1952 published at first their observations on the diuretic effect of heparin. The edema in a woman with congestive heart failure disappeared after the administration of heparin. Engelberg14) observed a similar effect in a patient with Kimmelstiel-Wilson syn drome. In the following years French and Belgian authors,31,22,32,13,7,8) reported on their observations. In their patients with nephrosis syndrome, heparin caused a considerable diuresis. Then, many authors have examined the mechanism of the diuretic effect of heparin; that is, its point of attack. Heparin causes diuresis in the cases of edemas of different etiology.25) Its character differs from that of the other diuretics, such as mercurials, chlorothiazide and carbonic anhydrase inhibitors, in that the effect is of the delayed type: it appears about 36-48 hours later, and lasts about 48 hours after the termination of medication. According to the data in the literature the quantity of heparin and the way of its administration varied considerably. The majority of the authors used dosages of 300 mg heparin for 3-4 days. As a manifestation of the diuretic effect, besides a strikingly large sodium chlorine excretion, a moderate urine excretion and slight potassium retention may be observed. All these occur in the distal renal tubuli. This excretion form is similar to that, which may be found in patients suffering from Addison's disease, or to that brought about on administration of Amphenone or Spirolactone. Based on these observations Majoor and co-workers25) presumed that the effect of heparin is produced through the intermediation of the adrenal cortex-by inhibiting aldosterone secretion. In ease of secondary aldosteronism several authors11,24) observed decrease of aldosterone excretion following the heparin administration. Majoor,24) however, mentioned 12 patients: 2 cases of Addison's disease, 6 cases of congestive heart failure, 3 cases of nephrosis syndrome and 1 case of mephritis chr. in which