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JOSEPH W. GOLDZIEHER, GILBERT C. H. STONE, THE RELATIVE INDEPENDENCE OF SODIUM AND CHLORIDE EXCRETION, The Journal of Clinical Endocrinology & Metabolism, Volume 9, Issue 4, 1 April 1949, Pages 368–371, https://doi.org/10.1210/jcem-9-4-368
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Abstract
IN THE early days of electrolyte studies, the concept of “salt” (i.e., sodium chloride) metabolism was widely used. This is exemplified by Zondek's “salt-and-water obesity,” a study which was based entirely on chloride determinations (1). Since that time it has been noted that sodium and chloride levels do not always follow a parallel course. In shock and in alkalosis, profound changes in blood chlorides occur with relatively little alteration of the sodium level. In cases of adrenal tumor, low plasma chlorides have been associated with high (2) or normal (3) plasma sodium values. Differences between the urinary excretion of sodium and chloride have been observed very recently in cardiac edema and in hepatic cirrhosis (4). Nevertheless, the habit of judging sodium metabolism by chloride values, and the expression of chloride concentrations as “milligram per cent of sodium chloride” or chloride output “as sodium chloride” persists. Extensive work on the relation of steroid hormones to electrolyte balance, as well as renewed interest in sodium metabolism as related to heart failure and hypertension, have emphasized the need for separate evaluation of sodium and chloride balance. With the availability of a simple method for the determination of sodium in biologic fluids, simultaneous balance studies of sodium and chloride were carried out to determine how frequently these substances are treated by the body in parallel fashion.
