MERCUSAL (Mercusalum) — diuretic; 10% solution of monosodium salt of connection of an angidroforma of carboxymethyl ether 2-metoksi-Z-rtutyoksipropilamida salicylic acid with 5,5-diethylbarbituric to - that (barbital); With 13 H 15 HgNO 5 Na-C 8 H 12 N 2 O 3 :
Colourless or almost colorless transparent liquid of alkali reaction; pH 7,2 — 8,2. Contains apprx. 4% of mercury.
Like other mercury diuretics (see. Diuretics ) The m blocks sulphhydryl groups of a number of enzymes in cells of an epithelium of renal tubules (hl. obr. in the ascending department of a Henle's loop where there is active transport of chlorine). As a result of it the reabsorption of sodium and chlorine decreases that leads to strengthening - a diuresis. The diuretic effect of M. begins in 2 — 3 hours after its intramuscular introduction, reaches a maximum in 4 — 8 hours and proceeds apprx. 24 hours and more. Drug is quickly soaked up; apprx. 90% of the entered dose it is allocated with urine within a day.
M. apply at the hypostases and developments of stagnation arising at hron. heart failure; at the cirrhosis which is followed by stagnation in system of a portal vein; at nefroza with the expressed edematous syndrome, and also at the venous stagnation connected with a prelum of large veins (e.g., at tumors of a mediastinum, etc.). The drug is administered only intramusculary on 0,5 — 1 ml of 1 times in 4 — 5 days (in the morning). Sometimes M. apply in fractional doses (0,25 — 0,3 ml) daily within 4 — 5 days or every other day within 8 — 10 days. The highest dose (one-time and daily) in a muscle for adults of 1 ml.
The m is highly toxic. Therefore it is applied only in cases when other diuretic means are ineffective. At M.'s introduction follows, having gathered drug through a needle in the syringe from an ampoule, to replace a needle to avoid M.'s hit under skin during an injection (the necrosis of fabrics is possible). Besides, M. needs to be applied controlling daily release of urine and its structure. Before an initiation of treatment of M. it is reasonable to carry out test on hypersensitivity to it, entering for this purpose no more than 0,5 ml of drug.
At hron, heart failure of M. should appoint together with cardiac glycosides (see), having at the same time in a look that owing to the strengthened allocation of potassium ions against the background of actions, sensitivity of heart to cardiac glycosides increases.
Except hypopotassemias (see), prolonged use of M. can be followed by gipokhloremichesky alkalosis (see) that leads to decrease in efficiency of drug. In such cases resort to appointment ammonium of chloride (see) or combine M. with Diacarbum (see), causing shift of acid-base equilibrium towards acidosis.
At hypersensitivity to M. weakness, a hyperemia of the person can be observed, small tortoiseshell (see), vasculitis (see). In the course of M.'s treatment development of mercury intoxication is possible, signs a cut are dispeptic frustration, strengthening of salivation, emergence of blood in excrements, etc. At heavy intoxication damage of kidneys is possible. At emergence of symptoms of intoxication drug is cancelled. As M.'s antidotes donators of sulphhydryl groups, napr apply, Unithiolum.
M. it is contraindicated at acute and hron, nephrite, nephrosclerosis, an amyloidosis of kidneys, an exacerbation of colitis, and also at insufficiency of concentration ability of kidneys (relative density of urine is lower than 1,018).
Form of release: ampoules on 1 ml. Keep in the cool, protected from light place.
See also Diuretics .
Bibliography: Lebedev A. A. and Kantariya V. A. Diuretics, Kuibyshev, 1976; CafrunyE. J. The site and mechanism of action of mercurial diuretics, Pharmacol., Rev., v. 20, p. 89, 1968, bibliogr.
E. B. Berkhin.