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Harry Mandelbaum, M.D.
JAMA. 1942;120(2):147. doi:10.1001/jama.1942.02830370059022.
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To the Editor:—  Reports of toxic reactions and an occasional death following thiocyanate therapy in hypertension tend to emphasize the need for care in the selection of patients for treatment and in their supervision while receiving this drug.Many of the pharmacologic properties of thiocyanates have been reviewed in the several publications by M. H. Barker: 1. The content of the thiocyanates in the blood is an index of the thiocyanate content of the tissues, and this depends on the intake and rate of excretion through the kidneys. 2. The rate of excretion of thiocyanates from the body is extremely variable. The only correlation is a tendency for the cyanate clearance to be depressed when the urea clearance is low (The Journal, March 25, 1939, p. 1120).Thus an important contraindication to the use of thiocyanates in vascular hypertension is seriously impaired renal function. The fatal outcome in the case


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