Acta med. scand. Vol. 197, pp. 307-309, 1975

THE URINARY EXCRETION OF TRACE ELEMENTS BEFORE AND DURING TREATMENT WITH HYDRALAZINE P. 0. Wester From the Department of Medicine, Karolinska Institutet at Serafimerlasarettet, Stockholm, Sweden

Abstract. Urinary excretion of antimony, arsenic,

bromine, cadmium, caesium, cobalt, copper, gold, iron, mercury, molybdenum, rubidium, scandium, selenium, silver, tungsten and zinc from five hypertensive patients before and during treatment with hydralazine has been investigated. The method consisted of neutron activation analysis combined with a recently developed ion exchange technique. The mean copper excretion during treatment with hydralazine was found to be more than twice that before treatment.

It is well known that after treatment with hydralazine some patients develop a syndrome (hydralazine disease) reminiscent of lupus erythernatosus disseminatus, the cause of which is unknown. Hydralazine, which is known to b e a good chelating agent (8, 9), has been reported to selectively bind manganese, ferrous iron, nickel, copper, silver, tin and mercury ( 5 ) and it has been suggested

Table I. 24-hour urinary excretion of trace elements (pg) with known biological function before and during treatment with hydralazine

cu

co Case no.

Before

During

1

0.83 0.32 0.40 0.52

0. I3 0.32 0.36 0.56

87 65 53 63

1.4

1.5

115

2 3 4 5

MeanfS.D. Mean difference

Before

0.69k0.44 0.57f0.54 -0.12

Fe During

Zn

Before

187 69 220 76 280

During

190

80

140

160

100

130 120

54

Before

During

290 1200 750 1000

250 1100

720 1000 440

500

77k25 166f92 +89*

121f58 123k33 +1.2

748f367 702k361 -46*

Table 11. 24-hour urinary excretion of trace elements (pg) with suspected biological function before and during treatment with hydralazine Br

Cd

Mo

Rb Before

During

Before During 3 49 33 38 52

Caseno.

Before

During

Before During

Before During

1

6 700 2900 3 700

6800 3 100 3 400 4 600 4600

2.2 0.24 2.7 8.4 6.8

100

2 3 4 5

4 500 3 500

MeankS.D. 4300+1500 4500fl50 Mean difference 4-240

1.8 0.19 5.9 9.6

4.1k3.4 4.4+42 --0.21

Se

56 66 180 81

84 65 95 140 56

2 100 2000 2 400 3 100

2 300 2 100 2 600

1900

97+49

88f33

2300k480

3 300 2400k550 35f20

--8.6

1900

+ I75

13 39 27 45 43 33k13

--0.32 Acra med. scand. 197

308

P. 0. Wester

Table 111. 24-hour urinary excretion of trace elements ( p g ) with no known biological function before and during treatment with hydralazine

Case no.

Before

During

Before

During

Before

1 2 3 4 5

0.46 0.43 0.37 0.41 0.47

0.32 I .6 0.52 0.58 0.28

42 610 100 85

2 10 510 67 66 86

0.00055 0.0021 0.066 0.00072 0.00087

Mean+S.D. Mean difference

0.43rt0.04 0.66f0.54 +0.23

110

cs

Au

As

Ag

190+240 1%+1% -2.2

that hydralazine disease may be related to a metal deficiency (2, 10). It has been reported that hypertensive patients excrete large amounts of cadmium and manganese in the urine and that treatment with hydralazine lowers the urinary excretion of these elements (6). However, in a previous study I found that the urinary excretion of 17 trace elements in untreated hypertensive patients did not differ significantly from that in normotensive subjects (1 I). The aim of the present study was to investigate the urinary excretion of antimony, arsenic, bromine, cadmium, cesium, cobalt, copper, gold, iron, mercury, molybdenum, rubidium, scandium, selenium, silver, tungsten and zinc in hypertensive patients before and during treatment with h ydralazine.

During

0.0044 0.019

Before

During

14

II 13 17

10

15

8.9 0.00087

I5 7.0

0,014rto.029 0 . 0 0 ~ ~ +1 2~+ 3., 0~ ~1 3 ~+ 3 , 8 -0.016 +2.0

ards, were irradiated for 24 hours. The chemical separation technique has been described elsewhere (7, 12). Statistical methods

The statistical analysis was undertaken with the paired t-test. The degrees of significance have been expressed as follows: -not significant, O.OS