Eight patients with serum calcium values ranging between 12.3 and 18.4 mg per 100 ml were treated with large doses of furosemide intravenously. Their urinary losses of water, sodium and potassium were measured and carefully replaced. Serum calcium was reduced to normal in three patients and to near normal in another three. In the remaining two patients serum calcium fell from 18.4 to 14.6, and from 18.0 to 14.8 mg per 100 ml. The mean fall in serum calcium was 3.1 mg, with a range of 2.3 to 3.8 mg per 100 ml. The decrease was the consequence of the excretion of 0.7 to 2.7 g of calcium in the period of diuresis. Magnesium losses were considerable and had to be replaced. This method of treatment appears safe in patients with compromised cardiac reserve, and effective even in patients with moderate renal insufficiency. The careful replacement of water and electrolyte losses (sodium, potassium and magnesium), however, is essential if this therapy is to be safe.
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