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NA: Comparison of Grim Protocol to Modified Grim Protocol (2009)


Grim Protocol
(Grim et al 1797)
Modified Grim Protocol
(Strazzullo et al 2000)
 Day 1 Admission
  • Urine collected
  • No Changes to usual diet
 Day 1 Admission
  • Dietary Na 50 mmol/d
  • 10 Slow-Na tablets to achieve total Na intake of 150 mmol/d
 Day 2 Arterlogram
  • No changes to usual diet

 Day 2 Saline Infusion
  • 150 mmol/d (diet + tablets)
  • 4 hour IV of 2 L isotonic (9.9%) saline (500 ml/hr)
 Day 3 Saline Infusion
  • 4 hour IV of 2 L isotonic (0.9%) salline (500 ml/hr)
  • Urine Collected
  • Thereafter, subject received a 150 mEq Na, 70 mEq K/d diet)
  • (TOTAL Na "intake" for this day was 458 mEq
 Day 3 Sodium and Volume Depletion 
  • Dietary Na 50 mmol/d
  • Water limited to 25 ml Hx0 per kg body weight
  • Frusemide (37.5 mg) given 3 times

 Day 4 Furosemide
  • Dietary Na limited to 10 mEq; K was 70mEq
  • Water limited to 25 ml H2O per kg body weight
  • Furosemide (40 mg) given three times
 Day 4
  • Dietary Na 50 mmol/d
  • Measurements

 Day 5 Post-sodium Depletion
  • Measurements



Grim CE, Luft FC, Miller JZ, Brown PL, Gannon MA, Weinberger MH. Effects of sodium loading and depletion in normotensive first-degree relatives of essential hypertensives. J Lab Clin Med. 1979 Nov;94(5):764-71.

Strazzullo P, Galletti F, Dessi-Fulgheri P, Ferri C, Glorioso N, Malatino L, Mantero F, Manunta P, Semplicini A, Ghiadoni L, Zoccali, C. Prediction and consistency of blood pressure salt-sensitivity as assessed by a rapid volume expansion and contraction protocol. Journal of Nephrology 2000 Jan-Feb;13(1):46-53.