I am glad we're having this discussion about the physiology of Epsom
salts (Mgso4) soaks. If we are going to try them, as the note in the ALCA
newsletter suggests, we as professionals really ought to know more about
the process. (though we still don't "know" about the cabbage process.)

Debbi originally wrote:

<Kermaline Cotterman writes

> and the epsom salts work
> mysteriously to reduce the edema.


Kermaline, this is no mystery.  When exposed to a hypertonic solution,
edema
will move out of cells.  Epsom salts provides a hypertonic solution.  >

Thanks to Debbi for her resonse. However, I didn't write that except in
quoting
Denise in my reply to her, in which I specified the supersaturated
solution (which is hypertonic by definition), and questioned if there
exists even the physiologic possibility of fluid being able to be drawn
through the skin. My words:

<It really isn't so mysterious when you think about it, because the
solution is usually made up to be a supersaturated one (dissolving the
most possible epsom salts that very warm water will dissolve), and
therefore it sounds as if it might somehow  create an osmotic attraction
to induce interstitial fluid to migrate outward through the skin to the
stronger solution, if that is in fact possible physiologically.>

Barb then asked:

<First of all, do we know that Epsom salts are actually absorbed through
the
skin?>

There was no suggestion on my part of it being *absorbed through* the
skin when I said:

<I had wondered because in my own family of origin (during the 1930's and
'40's) it was used to reduce swelling in other areas, especially when the
swelling had to do with infection, to "draw out the poisons" and "bring
them to a head".

I never had the nerve to try it on edematous mothers because I wondered
whether it would be extremely drying to the skin, especially the skin of
the nipple.>

Barb further writes

<The other thing is that edema is a phenomenon of *extracellular* fluid
(ie. interstitial, emphasis mine), not intracellular fluid.  Electrolyte
movement in and out of
cells is also a regulated  - ie. not entirely passive - phenomenon. >

That is my understanding too. In thinking about this, it seems like the
action of old-fashioned "drawing salve", or many of the folk medicines
involving application of salt pork, etc. to potential abcesses, long
before antibiotics. Those  remedies seemed to kill the bacteria by
drawing essential fluid out of THEIR cells through the cell walls.

In whatever manner the Epsom salts might get to them, might this be the
mechanism involved in clearing what sounds like plugged ducts or
beginning mastitis?? Might it saturate the plug, and cause it to draw
fluid through the duct walls to re-liquify it, allow it to pass, and the
accompanying swelling resolve on its own as a result of the clearing of
the plug?

And/or kill bacteria by drawing fluid out of their cells? That would be
an entirely different thing though than helping resolve excess
interstitial fluid (edema).

I recently learned a few things about edema that fit in here:

Edema is not "in the cell" to begin with. It's interstitial fluid (which
is one category of extracellular [outside the cell walls] fluid).
Interstitial fluid is essential to health. It is described as "the lake
that bathes the cells", allowing nutrients and wastes to be carried from
the capillary bed right to and from the cell wall. It is in the form of a
gel.

When 30% or more extra fluid than is normal for a particular organ
collects in the interstitial fluid, it is then termed edema. When it gets
from between 30-50% more than normal, it is very liquid and causes the
phenomenon known as "pitting".

What a great collection of ALCA articles ferreted out and quoted by
Karen. The editor had a very good suggestion whose time may finally have
come:

<ED: The safety and efficacy of all new interventions needs to be
established
before we recommend them generally. This seems like a harmless enough
practice. It could easily be tested for efficacy by setting up a trial
comparing the effects of warm water alone and water with Epsom Salts. Of
course warm water alone can be beneficial in this situation: We would be
looking to see if the addition of Epsom Salts made a difference. I guess
too
we'd need to look for the effect of different osmotic pressures by having
a
third trial group using another mineral compound (say, sodium
chloride/salt). Any scientists out there who'd like to Comment?>

This would really, really make a grand research project for some graduate
student in nursing, pharmacology, etc. Of course, as far as funding goes,
it would never bring any profit to the pockets of any pharmaceutical
company, but it certainly would "profit" moms and babes and their
caregivers in having some definitive answers to explain the action of a
possible new tool in our field!

Jean
*************
K. Jean Cotterman RNC, IBCLC
Dayton, Ohio USA (who needs to cut short her LN "break" and get busy with
last minute details of my DD's wedding tomorrow!)

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