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. 1987 Sep;58(3):230–238. doi: 10.1136/hrt.58.3.230

Total body electrolyte composition in patients with heart failure: a comparison with normal subjects and patients with untreated hypertension.

J G Cleland 1, H J Dargie 1, I Robertson 1, J I Robertson 1, B W East 1
PMCID: PMC1216442  PMID: 3311097

Abstract

Total body elemental composition was measured in 40 patients with well documented heart failure who were oedema-free on digoxin and diuretics. The results were compared with values for 20 patients with untreated essential hypertension matched for height, weight, age, and sex. Total body potassium alone was also measured in 20 normal subjects also matched for anthropomorphic measurements. Patients with hypertension had a very similar total body potassium content to that of normal subjects, but patients with heart failure had significantly reduced total body potassium. This could not be explained by muscle wasting because total body nitrogen, largely present in muscle tissue, was well maintained. When total body potassium was expressed as a ratio of potassium to nitrogen mass a consistent depletion of potassium was revealed in the group with heart failure. Potassium depletion was poorly related to diuretic dose, severity of heart failure, age, or renal function. Activation of the renin-angiotensin-aldosterone system was, however, related to hypokalaemia and potassium depletion. Such patients also had significantly lower concentrations of serum sodium and blood pressure. Serum potassium was related directly to total body potassium. Despite the absence of clinically apparent oedema total body chlorine was not consistently increased in heart failure, but the calculated extracellular fluid volume remained expanded in the heart failure group. Total body sodium was significantly increased in patients with heart failure, but less than half of this increase could be accounted for by extracellular fluid volume expansion. Potassium depletion in heart failure may account in part for the high frequency of arrhythmias and sudden death in this condition.

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Selected References

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  1. Atkinson A. B., Morton J. J., Brown J. J., Davies D. L., Fraser R., Kelly P., Leckie B., Lever A. F., Robertson J. I. Captopril in clinical hypertension. Changes in components of renin-angiotensin system and in body composition in relation to fall in blood pressure with a note on measurement of angiotensin II during converting enzyme inhibition. Br Heart J. 1980 Sep;44(3):290–296. doi: 10.1136/hrt.44.3.290. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Ball S. G., Tree M., Morton J. J., Inglis G. C., Fraser R. Circulating dopamine: its effect on the plasma concentrations of catecholamines, renin, angiotensin, aldosterone and vasopressin in the conscious dog. Clin Sci (Lond) 1981 Oct;61(4):417–422. doi: 10.1042/cs0610417. [DOI] [PubMed] [Google Scholar]
  3. Beretta-Piccoli C., Davies D. L., Boddy K., Brown J. J., Cumming A. M., East B. W., Fraser R., Lever A. F., Padfield P. L., Semple P. F. Relation of arterial pressure with body sodium, body potassium and plasma potassium in essential hypertension. Clin Sci (Lond) 1982 Sep;63(3):257–270. doi: 10.1042/cs0630257. [DOI] [PubMed] [Google Scholar]
  4. Boddy K., Elliott A., Robertson I., Mahaffy M. E., Holloway I. A high sensitivity dual-detector shadow-shield whole-body counter with an 'invariant' response for total body in vivo neutron activation analysis. Phys Med Biol. 1975 Mar;20(2):296–304. doi: 10.1088/0031-9155/20/2/011. [DOI] [PubMed] [Google Scholar]
  5. Boddy K., King P. C., Hume R., Weyers E. The relation of total body potassium to height, weight, and age in normal adults. J Clin Pathol. 1972 Jun;25(6):512–517. doi: 10.1136/jcp.25.6.512. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Boddy K., King P. C., Tothill P., Strong J. A. Measurement of total body potassium with a shadow shield whole-body counter: calibration and errors. Phys Med Biol. 1971 Apr;16(2):275–282. doi: 10.1088/0031-9155/16/2/310. [DOI] [PubMed] [Google Scholar]
  7. Brickman A. S., Massry S. G., Coburn J. W. changes in serum and urinary calcium during treatment with hydrochlorothiazide: studies on mechanisms. J Clin Invest. 1972 Apr;51(4):945–954. doi: 10.1172/JCI106889. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Brown J. J., Davies D. L., Johnson V. W., Lever A. F., Robertson J. I. Renin relationships in congestive cardiac failure, treated and untreated. Am Heart J. 1970 Sep;80(3):329–342. doi: 10.1016/0002-8703(70)90098-0. [DOI] [PubMed] [Google Scholar]
  9. Burkinshaw L., Morgan D. B. Mass and composition of the fat-free tissues of patients with weight-loss. Clin Sci (Lond) 1985 Apr;68(4):455–462. doi: 10.1042/cs0680455. [DOI] [PubMed] [Google Scholar]
  10. Cleland J. G., Dargie H. J., Ball S. G., Gillen G., Hodsman G. P., Morton J. J., East B. W., Robertson I., Ford I., Robertson J. I. Effects of enalapril in heart failure: a double blind study of effects on exercise performance, renal function, hormones, and metabolic state. Br Heart J. 1985 Sep;54(3):305–312. doi: 10.1136/hrt.54.3.305. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Cleland J. G., Dargie H. J., East B. W., Robertson I., Hodsman G. P., Ball S. G., Gillen G., Robertson J. I., Morton J. J. Total body and serum electrolyte composition in heart failure: the effects of captopril. Eur Heart J. 1985 Aug;6(8):681–688. doi: 10.1093/oxfordjournals.eurheartj.a061920. [DOI] [PubMed] [Google Scholar]
  12. Cleland J. G., Dargie H. J., Hodsman G. P., Ball S. G., Robertson J. I., Morton J. J., East B. W., Robertson I., Murray G. D., Gillen G. Captopril in heart failure. A double blind controlled trial. Br Heart J. 1984 Nov;52(5):530–535. doi: 10.1136/hrt.52.5.530. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Davidson C., Burkinshaw L., Morgan D. B. The effects of potassium supplements, spironolactone of amiloride on the potassium status of patients with heart failure. Postgrad Med J. 1978 Jun;54(632):405–409. doi: 10.1136/pgmj.54.632.405. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Davidson C., Gillebrand I. M. Use of amiloride as a potassium conserving agent in severe cardiac disease. Br Heart J. 1973 Apr;35(4):456–461. doi: 10.1136/hrt.35.4.456. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Davidson C., McLachlan M. S., Burkinshaw L., Morgan D. B. Effect of long-term diuretic treatment on body-potassium in heart-disease. Lancet. 1976 Nov 13;2(7994):1044–1047. doi: 10.1016/s0140-6736(76)90965-x. [DOI] [PubMed] [Google Scholar]
  16. Ellis J. K., Cohn S. H. Correlation between skeletal calcium mass and muscle mass in man. J Appl Physiol. 1975 Mar;38(3):455–460. doi: 10.1152/jappl.1975.38.3.455. [DOI] [PubMed] [Google Scholar]
  17. Ellis K. J., Vaswani A., Zanzi I., Cohn S. H. Total body sodium and chlorine in normal adults. Metabolism. 1976 Jun;25(6):645–654. doi: 10.1016/0026-0495(76)90061-5. [DOI] [PubMed] [Google Scholar]
  18. FLEAR C. T., COOKE W. T., QUINTON A. Serum-potassium levels as an index of body content. Lancet. 1957 Mar 2;272(6966):458–459. doi: 10.1016/s0140-6736(57)90525-1. [DOI] [PubMed] [Google Scholar]
  19. Franciosa J. A., Wilen M., Ziesche S., Cohn J. N. Survival in men with severe chronic left ventricular failure due to either coronary heart disease or idiopathic dilated cardiomyopathy. Am J Cardiol. 1983 Mar 1;51(5):831–836. doi: 10.1016/s0002-9149(83)80141-6. [DOI] [PubMed] [Google Scholar]
  20. Fraser R., Guest S., Young J. A comparison of double-isotope derivative and radioimmunological estimation of plasma aldosterone concentration in man. Clin Sci Mol Med. 1973 Sep;45(3):411–415. doi: 10.1042/cs0450411. [DOI] [PubMed] [Google Scholar]
  21. Haywood J. K., Harris I., Boddy K., Williams E. D. A two-way scanning method for total body in vivo neutron activation analysis. Phys Med Biol. 1978 Sep;23(5):865–875. doi: 10.1088/0031-9155/23/5/003. [DOI] [PubMed] [Google Scholar]
  22. Holland O. B., Nixon J. V., Kuhnert L. Diuretic-induced ventricular ectopic activity. Am J Med. 1981 Apr;70(4):762–768. doi: 10.1016/0002-9343(81)90530-1. [DOI] [PubMed] [Google Scholar]
  23. James H. M., Dabek J. T., Chettle D. R., Dykes P. W., Fremlin J. H., Hardwicke J., Thomas B. J., Vartsky D. Whole body cellular and collagen nitrogen in healthy and wasted man. Clin Sci (Lond) 1984 Jul;67(1):73–82. doi: 10.1042/cs0670073. [DOI] [PubMed] [Google Scholar]
  24. Lawson D. H., Boddy K., Gray J. M., Mahaffey M., Mills E. Potassium supplements in patients receiving long-term diuretics for oedema. Q J Med. 1976 Jul;45(179):469–478. [PubMed] [Google Scholar]
  25. Lever A. F., Beretta-Piccoli C., Brown J. J., Davies D. L., Fraser R., Robertson J. I. Sodium and potassium in essential hypertension. Br Med J (Clin Res Ed) 1981 Aug 15;283(6289):463–468. doi: 10.1136/bmj.283.6289.463. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Levine T. B., Franciosa J. A., Vrobel T., Cohn J. N. Hyponatraemia as a marker for high renin heart failure. Br Heart J. 1982 Feb;47(2):161–166. doi: 10.1136/hrt.47.2.161. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Lye M. Body potassium content and capacity of elderly individuals with and without cardiac failure. Cardiovasc Res. 1982 Jan;16(1):22–25. doi: 10.1093/cvr/16.1.22. [DOI] [PubMed] [Google Scholar]
  28. Lye M. Body potassium content and capacity of elderly individuals with and without cardiac failure. Cardiovasc Res. 1982 Jan;16(1):22–25. doi: 10.1093/cvr/16.1.22. [DOI] [PubMed] [Google Scholar]
  29. Lye M., Winston B. Whole body potassium and total exchangeable potassium in elderly patients with cardiac-failure. Br Heart J. 1979 Nov;42(5):568–572. doi: 10.1136/hrt.42.5.568. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. MacLennan W. J., Lye M. D., May T. The effect of potassium supplements on total-body-potassium levels in the elderly. Age Ageing. 1977 Feb;6(1):46–50. doi: 10.1093/ageing/6.1.46. [DOI] [PubMed] [Google Scholar]
  31. Meinertz T., Hofmann T., Kasper W., Treese N., Bechtold H., Stienen U., Pop T., Leitner E. R., Andresen D., Meyer J. Significance of ventricular arrhythmias in idiopathic dilated cardiomyopathy. Am J Cardiol. 1984 Mar 15;53(7):902–907. doi: 10.1016/0002-9149(84)90522-8. [DOI] [PubMed] [Google Scholar]
  32. Moore Ede M. C., Brennan M. F., Ball M. R. Circadian variation of intercompartmental potassium fluxes in man. J Appl Physiol. 1975 Jan;38(1):163–170. doi: 10.1152/jappl.1975.38.1.163. [DOI] [PubMed] [Google Scholar]
  33. Morgan D. B., Burkinshaw L., Davidson C. Potassium depletion in heart failure and its relation to long-term treatment with diuretics: a review of the literature. Postgrad Med J. 1978 Feb;54(628):72–79. doi: 10.1136/pgmj.54.628.72. [DOI] [PMC free article] [PubMed] [Google Scholar]
  34. Oparil S., Haber E. The renin-angiotensin system (first of two parts). N Engl J Med. 1974 Aug 22;291(8):389–401. doi: 10.1056/NEJM197408222910805. [DOI] [PubMed] [Google Scholar]
  35. Preston T., Reeds P. J., East B. W., Holmes P. H. A comparison of body protein determination in rats by in vivo neutron activation and carcass analysis. Clin Sci (Lond) 1985 Mar;68(3):349–355. doi: 10.1042/cs0680349. [DOI] [PubMed] [Google Scholar]
  36. Schalekamp M. A., Lebel M., Beevers D. G., Fraser R., Kolsters G., Birkenhäger W. H. Body-fluid volume in low-renin hypertension. Lancet. 1974 Aug 10;2(7876):310–311. doi: 10.1016/s0140-6736(74)91691-2. [DOI] [PubMed] [Google Scholar]
  37. Sealey J. E., Kirshman J. D., Laragh J. H. Natriuretic activity in plasma and urine of salt-loaded man and sheep. J Clin Invest. 1969 Dec;48(12):2210–2224. doi: 10.1172/JCI106187. [DOI] [PMC free article] [PubMed] [Google Scholar]
  38. Skrabal F., Arnot R. N., Joplin G. F. Equations for the prediction of normal values for exchangeable sodium, exchangeable potassium, extracellular fluid volume, and total body water. Br Med J. 1973 Apr 7;2(5857):37–38. doi: 10.1136/bmj.2.5857.37. [DOI] [PMC free article] [PubMed] [Google Scholar]
  39. Steiness E., Olesen K. H. Cardiac arrhythmias induced by hypokalaemia and potassium loss during maintenance digoxin therapy. Br Heart J. 1976 Feb;38(2):167–172. doi: 10.1136/hrt.38.2.167. [DOI] [PMC free article] [PubMed] [Google Scholar]
  40. Struthers A. D., Reid J. L. The role of adrenal medullary catecholamines in potassium homoeostasis. Clin Sci (Lond) 1984 Apr;66(4):377–382. doi: 10.1042/cs0660377. [DOI] [PubMed] [Google Scholar]
  41. Surveyor I., Hughes D. Discrepancies between whole-body potassium content and exchangeable potassium. J Lab Clin Med. 1968 Mar;71(3):464–472. [PubMed] [Google Scholar]
  42. Unverferth D. V., Magorien R. D., Moeschberger M. L., Baker P. B., Fetters J. K., Leier C. V. Factors influencing the one-year mortality of dilated cardiomyopathy. Am J Cardiol. 1984 Jul 1;54(1):147–152. doi: 10.1016/0002-9149(84)90320-5. [DOI] [PubMed] [Google Scholar]
  43. Wasnich R. D., Benfante R. J., Yano K., Heilbrun L., Vogel J. M. Thiazide effect on the mineral content of bone. N Engl J Med. 1983 Aug 11;309(6):344–347. doi: 10.1056/NEJM198308113090605. [DOI] [PubMed] [Google Scholar]
  44. Williams E. D., Boddy K., Brown J. J., Cumming A. M., Davies D. L., Harvey I. R., Haywood J. K., Lever A. F., Robertson J. I. Whole body elemental composition in patients with essential hypertension. Eur J Clin Invest. 1982 Aug;12(4):321–325. doi: 10.1111/j.1365-2362.1982.tb02239.x. [DOI] [PubMed] [Google Scholar]
  45. Williams E. D., Boddy K., Harvey I., Haywood J. K. Calibration and evaluation of a system of total body in vivo activation analysis using 14 MeV neutrons. Phys Med Biol. 1978 May;23(3):405–415. doi: 10.1088/0031-9155/23/3/004. [DOI] [PubMed] [Google Scholar]
  46. Williams E. D., Boddy K. Measurement of whole-body oxygen in living humans by neutron activation analysis. Int J Appl Radiat Isot. 1978 May;29(4-5):281–283. doi: 10.1016/0020-708x(78)90056-x. [DOI] [PubMed] [Google Scholar]

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