The Mercurial Diuretics

In congestive heart failure the heart is unable to keep up with its work and this often causes the feet to swell and the abdomen and lungs to fill up with fluid. Salyrgan, Mercuhydrin, or mercupurin is then injected into the body. They are diuretics, drugs that force the expulsion of large quantities of fluid through the kidneys. This relieves the heart of the added strain and protects it against the danger of collapse.

However, here too it is important to bear in mind that these remedies can be dangerous, and often cause additional damage or even collapse.

Dr. Leon Merkin, from the Cardiac Clinic of the City Hospital of New York, dealing with this subject, stated: With the rapid growth in the number of cases in which mercurial diuretics have been administered, we find in the literature an increasing number of reports of untoward effects resulting from the parenteral administration of these drugs. Among the side reactions the most important is the death of the patient shortly after the injection.

Dr. Merkin then gave, as illustrations of how dangerous these drugs can be, two case histories in which collapse followed the use of this remedy.5

Tetany, uremia, and in some cases stupor are some of the serious side reactions that occur from the use of these drugs.

One may wonder why these side-reactions and death are comparatively rare even though the number of injections reached thousands per day, Dr. Merkin asks. His own reply is that Side-reactions are much more frequent than doctors suspect. Very often these reactions are transient,

5 Untoward Effects of Treatment with Mercurial Diuretics, N.Y. State Journal of Medicine, October 15, 1949 and at the same time the clinical picture is obscured by other signs and symptoms arising from the heart failure.

Dr. Merkin pointed out that the administration of the mercurials leads to the excretion of many other essential elements, to a diminution of the alkalinity of the body, and to a disturbance in the balance between sodium and potassium that leads to a preponderance of potassium in the system.

On this point, Dr. Merkin writes that potassium intoxication results in widespread impairment of neuro-muscular function and that the accumulation of potassium in the body causes mortality and morbidity.

An editorial in the Journal of the American Medical Association, November 17, 1951, stressed that although congestive failure itself predisposes to thrombosis (a closing of a blood vessel) there is some evidence that this tendency is aggravated by currently accepted therapy for congestive failure and particularly by the injudicious use of mercurial diuretics and March and Pere, Russel and Zohuam, as well as the more recent findings of Marvel and Shullenberger, are cited to prove this fact.6

Henry A. Schroeder, in a report read before the intern session of the American Medical Association, asserted that the mercurial diuretics are of great value. Nonetheless, he pointed out, their use may lead to an excessive elimination of sodium chloride as well as other essential elements and that this can lead to serious consequences if not recognised. He stated further that this drug is sometimes excreted rather slowly, and said that the rather slow excretion of mercury can lead in certain subjects to the accumulation of toxic amounts.7

Flaxman, referring to the mercurial diuretics used in heart disease pointed out that cases of sudden death due to the use of these drugs and fatal mercurialism continue to be reported.8

Boyds remark in his chapter on Necrosis of the Liver that the introduction of the newer diuretics, such as the organic mercury compounds in association with ammonium chloride, has diminished the dangers of ascites (swelling) as a cause of death, only to bring into greater prominence that

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